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^A  DIGEST 


OP 


EXTERNAL   THERAPEUTICS^ 

WITH 

NUMEROUS  FORMULi^  ARRANGED  FOR  REFERENCE 

BY/ 

EGBERT  GUERNSEY  IfANKIN,  A.  M.,  M.  D. 

PHYSICIAN    TO   THE    METROPOLITAN   HOSPITAL, 

DEPARTMENT  OF  PUBLIC  CHARITIES, 

NEW  YORK. 


Second  Edition  Revised  and  Enlarged. 


BOERICKE  &  RUNYON  CO., 

NEW  YORK. 

1900. 


0  0 

lis 


WB330 


COPYRIGHTED 
BY 

BOERICKE  &  RUNYON  CO. 
1900. 


T.  B.  St  H.  B.  COCHRAN, 

PRINTERS 

LANCASTER,  PA. 


This  Book  is  Dedicated 

TO 

EGBERT  GUERNSEY,  M.  D., 

President  of  the  Medical  Board  of  the 

Metropolitan  Hospital, 

New  York, 

With  the  Affectionate 

Regard  of  the 

Author. 


Preface  of  the  Second  Edition. 


The  demand  for  a  second  edition,  in  so  brief  a 
period  after  the  appearance  of  the  first,  is  an  evi- 
dence of  approval  for  which  the  author  desires  to  ex- 
press his  appreciation  and  gratitude. 

The  book  has  been  carefully  revised  and  recent 
matter  incorporated.  It  is  obvious  in  a  work  of  this 
character,  that  Avhile  the  author's  approval  of  the 
matter  presented  should  generally  be  understood, 
some  subjects  are  of  so  recent  a  date  as  not  to  w^ar- 
rant  a  definite  conclusion. 

March  1,  1900. 


E.  G.  R. 

226  Central  Park  South, 

West  Fifty-Ninth  Street, 

New  York. 


Preface  to  the  First  Edition. 


It  is  not  the  purpose  of  this  book  to  give  undue 
prominence  to  external  therapeutics,  but  to  present 
the  subject  in  a  condensed  and  easily  accessible  form. 
No  attempt  has  been  made  to  cover  completely  so 
wide  a  field. 

The  remedies  and  remedial  measures  include  those 
which  are  the  more  important  and  generally  ac- 
cepted, and  have  been  selected  from  well  known  and 
recent  writers.  A  wider  range  of  authorities  might 
have  been  presented,  but  it  was  found  that  after  a 
certain  number  had  been  searched,  while  new  names 
were  added,  new^  subject  matter  w^as  not  thereby 
obtained. 

The  following  have  been  so  frequently  cited  as 
authorities  that  the  author  desires  to  acknowl- 
edge his  indebtedness :  Goodno,  Tyson,  Anders, 
Pepper,  Allbutt,  Ruddock,  Stedman's  Twentieth 
Century,  Practice  of  Medicine ;  Foster,  Barthe- 
low.  Ringer,  Hare,  Therapeutics;  Harrison  Allen, 
Local  Therapeutics ;  Carleton,  Bangs  and  Harda- 
way,  Genito-Urinary  Diseases ;  Van  Harlingen,  Kip- 
pax,  Jackson,  Crocker,  Hardaway,  Hyde,  Shoemaker, 
Unna,  Diseases  of  the  Skin ;  Burt,  Shoemaker,  Ma- 
teria Medica ;  Keating  and  Coe,  Southwick,  Cowper- 
thwaite,  Dudley,  Diseases  of  Women ;  Bosworth, 
Lennox  Browne,  Ivins,  Ingalls,  Bishop,  Diseases  of 


Vlll  PREFACE  TO  THE  FIRST  EDITION. 

Nose  and  Throat ;  Burnett,  Boyle,  McBride,  Bacon, 
Roosa,  Buck,  Diseases  of  the  Eye  and  Ear;  Kelsey, 
W.  and  H.  B.  AlHngham,  Andrews,  Gant,  Diseases 
of  the  Rectum  and  Anus ;  Jacobi,  Holt,  Diseases  of 
Children;  Wyeth,  Dennis,  Park,  Treves,  Holmes, 
Helmuth,  Surgery;  Treat's  International  Medical 
Annual  for  1896, 1897  and  1898,  andSajous'  Annual. 


September  1,  1899. 


E.  G.  R. 

226  Central  Park  South, 

West  Fifty-Ninth  Street, 
New  York. 


NOTE. 

The  initials  and  abbreviations  which  appear  at  the  end  of 
paragraphs  throughout  this  work  are  explained  by  the  Key  of 
References  on  page  723. 


Digest  of  External  Therapeutics. 


ABSCESS. 


ACUTE  ABSCESS. 

If  seen  early,  suppuration  may  sometimes  be  pre- 
vented. The  following  measures  are  recommended 
with  this  end  in  view: 

Rest  and  elevate  the  part ;  cleanse  the  surface  with 
Antiseptic  Soap  and  spray  with  a  2  per  cent,  solution 
of  Carbolic  Acid  or  Hydrogen  Peroxide  for  ten  min- 
utes every  two  hours,  or  apply  compresses  suturated 
in  hot  solutions  of  Corrosive  Sublimate  1-4,000. 
If  the  lesion  is  situated  on  the  lower  extremity  the 
same  solutions  may  be  employed  in  the  form  of 
baths. 

Cocaine : — When  pain  is  very  severe  the  anode 
sponge  of  a  galvanic  battery,  saturated  in  a  10  per 
cent,  solution  of  cocaine,  may  be  applied  for  five 
minutes  every  three  hours,  with  a  current  not  ex- 
ceeding five  milliamperes ;  during  the  intervals  apply 
Warm  Fomentations  with  Borated  or  Camphorated 
Water  or  an  Infusion  of  Poppies.     (Saj.) 

Menthol: — 10  to  50  per  cent,  ethereal  solutions 
painted  on  with  a  camel's  hair  brush  two  or  three 
times  a  day  control  small  abscesses.     (Al.) 

Menthol  Phenol : — A  5  per  cent,  solution  in  warm 
v^ater  has  been  used  successfully  for  its  anaesthetic 
2 


2      DIGEST  OF  EXTERNAL  THERAPEUTICS. 

and  antiseptic  qualities  in  painful  abscess  of  the 
finger.  A  2  per  cent,  gauze  may  be  employed  as  a 
dressing  with  good  effect.     (B.  M.  S.  J.  1,  20,  96.) 

Carbolic  Acid  : — See  Carbuncles  and  Boils. 

Nitrate  of  Silver : — This  drug  is  very  highly  praised 
by  Mr.  Higginbottom,  the  author  of  the  method, 
who  regards  it  as  efficacious  in  subduing  external  in- 
flammation:  "The  affected  parts  should  be  well 
washed  with  soap  and  water  then  with  water  alone 
to  remove  everj'  particle  of  soap,  as  soap  decomposes 
nitrate  of  silver,  then  wiped  dry  with  a  soft  towel. 
The  concentrated  solution  of  nitrate  of  silver,  4  scru- 
ples to  4  drachms  of  distilled  water,  is  then  applied 
tw^o  or  three  times  on  the  affected  surface  and  beyond 
it  on  the  healthy  skin  to  the  extent  of  two  or  three 
inches.  The  solution  may  be  applied  w^ith  a  soft 
piece  of  linen  on  the  end  of  a  stick.  In  about  twelve 
hours  it  will  be  seen  whether  it  has  been  well  applied. 
If  any  inflamed  part  is  unaffected  the  solution  must 
be  immediately  reapplied." 

The  following  also  mentioned  under  cellulitis  is  not 
only  applicable  to  that  condition,  but  will  also  prove 
effective  in  abscess,  under  its  influence  in  conjunc- 
tion with  moist  heat  infiltration  assumes  a  more 
kindly  hue  and  pus  is  sometimes  absorbed  : 

Ichthol,  lo  parts. 

Resorcin,  5  parts. 

Mercurial  Ointment,  35  parts. 

Lanolin,  50  parts. 

(Pk.) 

Alum  and  Plumb.  Acetate : — The  following  (for- 
mula of  Yon  Bulow)  is  highly  endorsed  as  effective 
for  subduing  local  inflammation,  it  is  non-poisonous, 


ABSCESS.  3 

astringent,  mildly  antiseptic,  and  almost  non-irritat- 
ing : 

1^.    Aluminis,  S'^j- 

Plumb.  Acetat.,  ^ixss. 

Aquae,  Oij. 

M. 

Sig. — Filter  and  allow  to  stand  twenty  hours  before  using.   (W.C.) 

Cold  : — In  local  inflammations  is  generally  preferred 
to  heat  by  patients ;  use  ice  bag  or  Leiter's  coil.  (W.) 

Continuous  Antiseptic  Applications  : — When  the 
skin  is  broken,  in  place  of  poultices  apply  layers  of 
gauze  soaked  in  solutions  of  bichloride  and  cover  with 
rubber  dressing.  This  will  act  somewhat  as  a  poul- 
tice. (W.  C.)  A  hot  water  bag  ma3'^  also  be  applied 
over  the  gauze. 

Poultices  : — Will  sometimes  abort,  as  well  as  hasten 
maturation ;  they  are  generally  made  of  flaxseed 
meal,  and  should  be  applied  only  up  to  the  time  of 
suppuration,  never  after,  or  to  open  incisions.  (W.  C.) 

Tr.  Opii  or  Tr.  Bell.: — Poured  over  poultices  use- 
ful to  relieve  pain. 

If  suppuration  is  unavoidable,  incise  as  soon  as 
presence  of  pus  is  ascertained.  For  anaesthesia  of 
the  surface:  Cocaine  5  per  cent,  solution,  twenty 
drops  subcutaneously  near  the  abscess;  sprays  of 
Ethyl  Chloride,  Ether,  or  Ethyl  Bromide  ;  the  latter 
especially  valuable.  (Sj.) 

Incision  : — The  parts  should  first  be  thoroughly 
cleansed  and  rendered  aseptic.  The  incision  should 
be  planned  so  as  to  run  parallel  with*  important 
structures,  and  of  sufl5cient  depth  to  freely  expose 
the  cavity ;  the  opening  should  be  made  in  as  depend- 
ent a  portion  as  possible  to  facilitate  drainage.  Ab- 
scess of  the  limbs  should  be  opened  longitudinally,  in 


4  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

those  of  the  anus  and  breast,  the  incisions  should 
radiate  from  the  part.  Deeply  seated  abscesses  and 
those  near  large  vessels  should  be  opened  bj^  Hilton's 
method ;  this  consists  of  making  an  incision  through 
the  skin  and  deep  fascia;  a  director  is  then  pushed 
into  the  abscess  cavity,  the  escape  of  pus  showing 
when  this  is  reached ;  a  pair  of  closed  dressing  for- 
ceps is  then  inserted,  and  withdrawn  with  distended 
blades,  thus  enlarging  the  opening,  a  counter  open- 
ing may  be  made  if  possible  when  the  cavity  is  deep, 
and  a  drainage  tube  inserted.     (Whar.) 

After  evacuation  of  pus,  some  surgeons  irrigate  the 
cavity ;  others  leave  it  to  nature  or  pack  w^ith  iodo- 
form gauze  for  the  first  twenty -four  hours  and  irri- 
gate at  the  second  dressing.     (W,  C.) 

The  following  solutions  are  used  for  irrigation : 

Mercuric  Bichloride  :  1-4,000  or  5,000. 

Carbolic  Acid  :  1-40  or  50. 

Hydrogen  Peroxide  :  1—8,  or  stronger. 

Boric  Acid :  Saturated  solution. 

Alumnol :  1-5  or  10. 

Dressing  : — If  the  abscess  cavity  is  small  no  drain- 
age tube  is  necessary ;  a  small  piece  of  gauze  should 
be  placed  between  the  edges  of  the  incision  to  prevent 
adhesion.  When  the  cavity  is  large  a  drainage  tube 
or  a  substitute,  such  as  a  strip  of  iodoform  gauze, 
should  be  introduced  to  the  bottom  of  the  cavity, 
and  fastened  with  a  safety  pin  at  the  surface. 
(Whar.)  The  dressing  should  consist  of  a  strip  of 
gauze  soaked  in  a  bichloride  solution  laid  directly 
over  the  incision,  over  this  layers  of  cotton  moist- 
ened with  the  same  solution,  then  dry  gauze ;  over 
this  in  turn  a  piece  of  protective  or  oiled  silk,  and  the 
whole  held  in  place  by  a  roller  bandage.    Some  sur- 


COLD   ABSCESS.  5 

geons  use  plain  sterilized  cotton,  but,  in  view  of  the 
discharge,  the  bichloride  cotton  is  preferred  by  many. 
(W.  C.)  In  exceptional  cases  an  aseptic  poultice, 
made  of  flaxseed  meal,  and  a  solution  of  bichloride  of 
mercury,  1-5,000,  may  be  applied.     (W.) 

The  frequency  of  changing  the  dressing  will  depend 
upon  the  amount  of  discharge ;  as  a  rule,  it  should  be 
changed  the  following  day.  At  each  dressing  the 
cavity  should  be  irrigated  with  the  selected  anti- 
septic solution  and  the  orifice  and  surrounding  surface 
cleansed  with  a  solution  of  bichloride  of  mercury  1- 
2,000.  The  drainage  tube  should  be  shortened  as 
required  and  not  removed,  as  it  is  difficult  to  insert 
again.  If  found  protruding  between  the  retaining 
stitches  it  should  be  cut  off.  In  most  instances  it 
can  be  dispensed  with  on  the  fourth  or  fifth  day. 
The  presence  of  a  serous  discharge  indicates  its  re- 
moval. A  short  tube  is  sometimes  necessary  during 
the  process  of  resolution  to  prevent  closure  of  the 
orifice  and  retention  of  pus.     (C.  B.) 

COLD  ABSCESS. 

The  majorit3^  of  abscesses  of  this  variety  are  tuber- 
culous, though  some  may  be  syphilitic.  Ordinarily 
tuberculous  abscesses  contain  pyogenic  membrane, 
but  the  syphilitic  do  not.  Abscesses  of  this  class 
should  be  opened  with  everv  antiseptic  precaution. 
(A.) 

Aspiration : — Should  generally  be  preferred,  as 
evacuation  by  this  method  avoids  shock  and  haemor- 
rhage ;  a  large  needle  should  be  employed  to  prevent 
occlusion  b3^  masses  of  thickened  lymph.  After  the 
removal  of  pus  irrigate  freely  with  a  saturated  solu- 


6  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

tion  of  Boric  Acid  or  Iodoform.  The  puncture  should 
be  carefully  sealed  with  iodoform  gauze  and  col- 
lodion.    (A.) 

Another  method  is  as  follows :  Withdraw  the  pus 
with  an  aspirator,  then  inject  a  5  per  cent,  solution  of 
Carbolic  Acid,  afterw^ards  aspirate,  and  renew  the 
procedure  until  the  solution  comes  out  clear,  then 
apply  Lister's  bandage  with  slight  pressure.  Four 
days  later  the  same  treatment :  about  five  sittings 
are  said  to  be  required.  Iodoform  may  be  injected 
in  the  same  way,  but  should  not  be  renewed  as  long 
as  the  remedj^  is  excreted  in  the  urine  (for  formula 
see  paragraph  on  this  drug).  Boric  Acid,  4  per  cent, 
solution,  may  also  be  used  in  this  manner.     (Sj.) 

Puncture: — This  method  of  evacuating  the  con- 
tents of  a  cold  abscess  is  often  preferable  to  aspira- 
tion, from  the  fact  that  masses  of  lymph  are  liable  to 
occlude  the  canula  of  the  aspirator.  The  puncture  is 
made  with  a  bistoury  ;  the  opening  enlarged  with  a 
director  and  antiseptic  irrigations  and  dressings  ap- 
plied as  mentioned.     (Whar.) 

Incision  and  Curettage  : — This  method  is  to  be  con- 
sidered when  aspiration  has  failed.  It  is  suited  to 
abscesses  with  few  ramifications  and  those  easily  ac- 
cessible to  the  curette. 

The  strictest  and  most  complete  antisepsis  is  es- 
sential, and  unless  this  condition  can  be  obtained 
cold  abscesses  should  not  be  incised.  The  incision 
should  be  free,  the  cavity  thoroughly  disinfected, 
curetted  clean,  iodoformized,  sutured  and  treated  as 
a  recent  wound.  The  possible  presence  of  necrosed 
or  detached  bone  should  not  be  forgotten. 

When  a  spontaneous  opening  occurs  there  should 
be  a  free  incision,  thorough  curettage  of  the  abscess 


COLD   ABSCESS.  7 

wall,  thus  transferring  the  suppurating  surfaces  into 
bleeding  ones,  and  thorough  irrigation  with  an  anti- 
septic solution.  A  long  drainage  tube  should  be  in- 
serted, and  the  wound  stitched  up  as  far  as  the 
drain.     (C.  B.) 

Volkmann's  curette  is  recommended,  and  for  irri- 
gation a  5  per  cent,  solution  of  carbolic  acid.     (Sj.) 

Hyperdistension  of  the  walls  of  an  abscess  cavity 
with  an  antiseptic  fluid,  after  the  removal  of  pus, 
was  recommended  by  Mr.  Callender.     (A.) 

Iodoform  : — Formulae  for  injection : 

Iodoform,  lo  parts. 

Glycerine,  20  parts. 

Mucil.  Gum  Acacia,  5  parts. 

Carbolic  Acid,  i  parti 

Water,  100  parts. 

Inject  2  or  3  ounces  at  intervals  of  three  or  four  weeks. 

This  is  safe  as  far  as  iodoform  poisoning  is  con- 
cerned.   Billroth 's  formula  is  as  follows  : 

Iodoform,  i  part. 

Glycerine,  10  parts. 

A  5  per  cent,  ethereal  solution  is  also  recommended  ; 
it  causes  considerable  pain ;  not  more  than  3  ounces 
should  be  injected. 

Iodoform,  •  i  part. 

Ether,  5  parts. 

Distilled  Water,  5  parts. 

(Mosetig-Moorhof,  Verneuil.)     (A.) 

Iodoform  poisoning  may  be  prevented  by  subject- 
ing it  and  its  excipient  (omitting,  of  course,  the  ether) 
to  a  temperature  212°.     (Saj.) 

lodol : — As  a  substitute  for  iodoform  has  been  rec- 
ommended on  account  of  the  absence  from  odor  but 
it  is  not  as  effective.     (See  Adenitis.) 


8  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Resorcin : — Cavities  may  be  flushed  with  a  5  per 
cent,  solution,  and  afterwards  dressed  with  the 
powder.    (Al.) 

Iodine  : — Solutions  sometimes  employed  after  free 
incisions,  especially  for  scrofulous  abscesses.     (B.) 

Phosphate  of  Lime  : — Gauze  soaked  in  a  5  per  cent, 
solution  for  packing  cavity.     (Al.) 

Potass.  Permang.: — 3J-0j  of  water  to  correct  fetor. 
(B.) 

Cloves  : — A  10  per  cent,  emulsion  in  olive  oil  in- 
jected into  tuberculous  regions  has  proved  beneficial. 
A  10  per  cent,  solution  of  the  essence  in  olive  oil  has 
also  been  employed.  From  30  to  300  drops  were  in- 
jected at  intervals  of  a  week,  the  time  depending 
upon  the  rapidity  with  which  the  oil  was  absorbed. 
(F.) 

Naphthalene : — The  following  formula  is  recom- 
mended for  injection :  Naphthalene,  sij ;  alcohol,  lij ; 
w^ater,  .^iv ;  the  water  should  be  added  hot  and  the 
whole  filtered,  since  the  crystals  will  clog  the  syringe ; 
the  solution  must  be  warmed  before  using ;  after 
evacuation  the  cavity  should  be  gently  distended. 
(Al.) 

For  dressing,  the  substitutes  for  iodoform,  as 
Loretin,  Europhen,  Boric  Acid,  Methylene  Blue,  etc. 

The  solutions  used  for  irrigation  in  acute  abscess 
are  equally  applicable  to  those  of  the  cold  or  chronic 
variety. 


ACNE  SIMPLEX. 

Local  treatment    is    of   great    importance.    In  a 
limited  number  of  cases  when  there  is  much  heat, 


ACNE   SIMPLEX.  9 

redness,  and  acute  inflammation,  mild  Abashes  and 
bland  ointments,  such  as  those  employed  for  eczema 
of  the  face,  are  indicated. 

Bathing  with  hot  water,  and  the  use  of  medicated 
soaps,  such  as  Sulphur,  Ichthyol,  Bichloride  of  Mer- 
cury, or  Salicylic  Acid,  should  precede  the  use  of  all 
lotions  and  ointments.  The  bathing  should  be  prac- 
ticed twice  daily,  once  with  hot  water  and  once  w^ith 
soap.  In  mild  cases  with  little  irritation  this  will 
often  be  all  that  w^ill  be  required. 

Boric  Acid : — Saturated  solutions  in  96  per  cent, 
alcohol,  sopped  on  or  applied  with  a  compress,  may 
be  employed  with  advantage  after  the  usc  of  medi- 
cated soaps.     (Vn.) 

Hydrarg.  Bichlorid.:  —  This  is  indicated  when 
stronger  remedies  are  required  : 

9;.    Hydrarg.  Bichlorid.,  gr.  vj-xij. 

Alcohol.,  ^iss. 

Aq.  Destill.,  Jiv. 
M. 

Dilute  with  water  at  first  and  gradually  increase. 
The  patient  should  be  warned  against  possible  irri- 
tating effects.     (Vn.) 

'*  Hebra's  Oriental  Solution,"  a  popular  remedy,  is 
as  follows : 


9;.    Hydrarg.  Bichlorid., 

gr-  viij. 

Aq.  Destill., 

liv. 

Succi  Limonis, 

No.  ij. 

Albumin.  Ovi, 

No.  vj. 

Sac.  Alb., 

3J- 

M. 

The  following  is  much  used  : 

Jfc.    Hydrarg.  Bichlorid., 

gr.  iv-viij 

Tr.  Benzoin., 

Sss-j. 

Emul.  Amygdal.  Amar., 

ad.  ^iv. 

M. 


10     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

"Gowland's  Lotion:" — 1  part  each  of  mercuric 
bichloride,  and  ammon.  chloride,  and  200  of  emul- 
sion of  bitter  almonds ;  this  forms  an  excellent  prep- 
aration.    (Vn.) 

Sulphur : — Serviceable  in  more  severe  cases,  and 
one  of  the  most  effective  remedies. 

The  addition  of  camphor  is  sometimes  desirable; 
the  following  makes  a  stimulating  lotion : 

p;.    Sulphur.  Sublimat.,  ^ij. 

Tr.  Camphor.,  3J. 

Aq.  Destill.,  giv. 
M.  (Ga.) 

Another  combination  forming  an  ointment  is : 

fl.    Sulphur.  Praecipitat.,  3J. 

Pulv.  Camphor.,  gr.  xx. 

Ung.  Aq.  Rosae, 

Petrolat.,  aa  ^iv. 

M. 

Kummerfield's  Lotion : — Forms  an  excellent  w^ash 
in  many  forms  of  the  disease ;  it  is  as  f ollow^s : 

p.    Sulphur.  Prsecipitat.,  3ij-iv. 

Pulv.  Camphor.,  gr.  x-xx. 

Pulv.  Tragacanth.,  9j-ij- 
Aq.  Calcis, 

Aq.  Rosae,  aa  ^ij. 

M.  (Al.) 

Other  useful  formulae  are  as  follows : 

^.    Sulphuris,  3J. 

Glycerini,  3j. 

Alcoholis,  3  iv. 

Aq.  Rosae,  ^iv. 
M.  (Kp.) 

Or 

9;.    Sulphur.  Praecipitat.,  ^iiss. 

Spts.  Vini  Rect.,  ^iss. 

Lanolini,  .i^jiiss. 

Glycerini,  M.  xx. 
M.  (Hy.) 


ACNE   SIMPLEX.  11 

When  the  skin  is  verj'  sluggish  the  following : 

^.    Potass.  Sulph.,  9j. 

Tr.  Benzoin.,  3J. 

Glycerini,  Siss. 

Aq.  Rosse,  ad.  ^iv. 
M. 

Or 

1^.    Potass.  Sulphuret., 

Zinc.  Sulphat.,  aa  3J. 

Aq.  Rosse,  ^iv. 

M. 
The  ingredients  are  each  dissolved  in  one  half  the  quantity  of 
water,  forming  a  clear  solution.     They  are  then  mixed;  a  white 
precipitate  falls  which  is  to  be  shaken  and  applied  to  the  face. 

Dilute  at  first  and  gradually  use  stronger,  not  suited  to  irritable 
skins.     (Vn.) 

Vlemingckx's  Solution  : — (See  Appendix  II.  for  for- 
mula.) One  of  the  best  preparations  for  acne  sebor- 
rhoeca.  Of  this  take  1  part,  and  10  of  water  and 
mix  in  a  bottle ;  weaker  solutions  should  be  used  on 
sensitive  skins.  Wash  the  face  gently  until  a  slight 
burning  sensation  results,  allow  the  lotion  to  dry  on 
and  w^ash  it  off  the  next  morning  with  soap  and 
water;  once  or  twice  a  -week  the  mixture  is  made 
stronger.  (B.  H.)  Sulphur  and  mercury  should  never 
be  combined. 

For  the  papular  variety : 

In  mild  cases  lather  the  part  with  castile  soap  and 
hot  water,  and  rub  well  with  a  towel.  The  lather 
may  be  mixed  with  fine  sand  or  marble  dust,  or  sand 
soap  may  be  used. 

When  comedones  are  deeply  seated  and  numerous, 
they  should  be  squeezed  out  after  lathering,  using  the 
thumb  protected  with  a  handkerchief  or  a  comedone 
extractor.     (B.  H.) 

Sapo  Viridis : — After  removal   of  comedones  this 


12  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

may,  in  solution,  be  applied  bj^  means  of  a  piece  of 
coarse  flannel,  using  the  f olloAving  formula : 

ffc.    Sapo.  Virid.,  ^j. 

Alcohol.  Fort.,  ^ij. 

Aq.  Destill.,  5"]- 

vSpts.  Lavandul,  ^ss. 

M. 

Sig. — Rub  into  the   skin  thoroughly  and  wash  oflF  the  next 
morning. 

This  may  be  continued  until  redness  and  scaling  is 
produced,  when  bland  salves  should  be  applied.  When 
the  inflammation  has  disappeared  the  green  soap 
may  be  used  again,  if  necessary,  or  if  the  larger 
comedones  have  disappeared,  apply  Vlemingckx's 
solution.     (B.  H.) 

Another  method  consists  in  rubbing  on  the  green 
soap  briskly  for  a  few  minutes,  and  then  washing  it 
off  and  powdering  with  starch  or  anointing  with 
cold  cream.     (Vn.) 

Ichthyol : — Recommended  by  Unna,  who  used  an 
ichthyol  soap  for  washing  the  parts  night  and  morn- 
ing and  then  applied  the  following : 

5fc.    Ammon.  Sulpho-ichthyolayat.,  g^.  ij-^ij. 

Alcoholis,  96  per  cent., 

Etheris,  aa     3  iv. 

M. 

The  application  can  remain  on  over  night.    If  too 

irritating  it  can  be  removed  in  half  an  hour  and  the 

following  applied : 

9;.    Acid.  Borici,  3  ss. 

Acid.  Salicylici,  gr.  x. 

Ung.  Zinc.  Oxidi,  Jj. 
M. 

It  is  advisable  to  commence  with  the  weaker  solu- 
tions of  ichthyol.     (Vn.) 

Resorcin : — A  good  remedy ;  15  to  20  per  cent, 
paste,  viz : 


ACNE   SIMPLEX.  13 

^.    Resorcini,  3J~iss. 

Zinc.  Oxid., 

Amyl.  Maydis,  aa     3ij- 

Ung.  Aq.  Rosse,  S^s. 

01.  Olivae,  q.  s. 
M. 

Apply  at  night  at  first  for  five  minutes,  then  re- 
move v^ith  a  dry  cloth  ;  continue  applying  each  night, 
lengthening  the  time  until  forty-five  minutes  have 
been  reached.  A  good  deal  of  redness  and  scaling 
may  be  produced,  which  should  be  treated  in  the 
same  way  as  described  in  the  use  of  green  soap. 
(B.  H.) 

A  milder  preparation  suited  to  less  severe  cases, 
when  inflammation  and  congestion  have  partly  sub- 
sided, is  as  follows: 

9^.    Resorcini,  5J- 

Glycerini.,  3J- 

Aq.  Aurant.  Flor.,  3vj- 

Spts.  Vini  Rect.,  ,^iij. 

M.  (Kp.) 

Naphthol: — In  severe  cases  the  following  paste 
mav  be  applied : 

Jfc.    Naphtholi,  9iiss. 

Sulphur.  Prsecipitat.,  ^ss. 

Lanolini, 

Sapo.  Virdis,  aa     3ij- 

M.  (Kp.) 

Allow  to  remain  on  fifteen  to  thirty  minutes  every 
night,  then  remove  w^ith  cotton  soaked  in  olive  oil 
and  wash  with  soap  and  water.  A  severe  inflamma- 
tion and  desquamation  can  be  produced  by  this  paste 
in  a  few  days.  As  soon  as  irritation  is  severe,  which 
may  be  after  two  or  three  applications,  the  remedy 
must  be  discontinued,  and  cold  cream  applied. 
(B.H.) 


14  DIGEST   OF   EXTERNAIv  THERAPEUTICS. 

A  milder  preparation,  recommended  by  Brocq,  is  as 
follows : 


?fc.    Naphtholi, 

Camphorse, 

Resorcini, 

aa    gr.  viij 

Sulphuris, 

gr.  xlv, 

Sapo.  Viridis, 

gr-  xij. 

Vaselini, 

3v. 

M. 

Sig. — Allow  to  remain 

on  over 

night. 

In  acne  indurata,  Shoemaker  recommends  the  fol- 
lowing line  of  treatment :  All  glandular  and  subcu- 
taneous abscesses  should  be  punctured,  and  the  con- 
tents removed ;  a  bistoury  should  be  used,  w^hich 
must  enter  deeply.  Ten  to  fourteen  sittings  will  be 
necessary.  The  hgemorrhage  which  will  be  consider- 
able may  be  controlled  by  cold  compresses.  Haemor- 
rhagic  and  flabby  infiltrations  should  be  scraped  out 
with  a  sharp  spoon,  and  fringes  of  skin  removed  with 
the  scissors.  At  the  end  of  ten  to  fourteen  days  when 
all  large  fluctuating  nodules  have  been  removed,  and 
small  ones  only  remain,  the  following  is  advised  :  (1) 
Mechanically  express  comedones  and  incise  incipient 
abscesses;  (2)  Employ  constant  and  vigorous  wash- 
ing with  soap  (toilet  soap,  soft  soap,  spts.  sapo.  kal., 
iodine,  sulphur,  naphthol,  etc.),  combined  with  va- 
por and  douche  baths  ;  (3)  Apply  such  remedies  as 
will  cause  rapid  exfoliation  of  the  epidermis  as  well 
as  of  the  lining  cells  of  the  sebaceous  glands,  thus  re- 
lieving them  of  their  contents  and  causing  contrac- 
tion; for  this  purpase  employ  the  soaps  just  men- 
tioned, together  with  sulphur  and  mercurial  plasters 
and  cold  douches ;  (4)  Protective  ointments,  lotions 
and  powders.     (Sh.) 

Van  Harlingen    recommends    that    afler  opening 


ACNE  SIMPLEX.  15 

larger  suppurating  lesions,  the  contents  should  be 
gently  expressed  and  pure  Ichthyol  introduced  into 
the  cavity  on  a  small  probe  or  sharpened  stick ;  he 
adds  that  too  much  pressure  should  be  avoided  in 
emptying  the  pustules  as  it  is  possible  thereby  to 
create  new  foci  of  suppuration. 

Carbolic  Acid : — 5  per  cent,  solution,  for  applica- 
tion to  the  skin  after  removal  of  comedones.    (B.  H.) 

Salicylic  Acid : — 1  to  3  per  cent,  solution  in  alcohol 
especially  indicated  for  the  pustular  form.     (B.  H.) 

A  50  per  cent,  plaster  may  by  applied  after  opening 
pustules.     (T.  96.) 

Vlemingckx's  Sol.  Spts.,  Sapo.  Kal.,  Resorcin,  and 
Naphthol  may  also  be  used  with  advantage  in  this 
variety  of  the  disease.     (B.  H.) 

Oleate  of  Mercury: — 5  per  cent.,  3  drachms,  olive 
oil  1  ounce,  w^ell  mixed  and  applied  at  night  is  useful 
in  obstinate  cases.    (Kp.). 

Massage  with  a  rubber  ball  was  suggested  by  J.  N. 
Hyde  for  indolent  and  intractable  cases.  The  skin  is 
first  operated  upon  with  a  disinfected  needle,  and 
comedo  extractor,  until  all  pustules  and  sub-epider- 
mic foci  and  prominent  comedones  are  removed.  The 
surface  is  then  rendered  aseptic  by  a  solution  of  bi- 
chloride of  mercury  or  formalin,  1  to  2  per  cent.,  the 
latter  preferred.  The  massage  ball  is  then  firmly  ap- 
plied, and  by  deep  pressure  other  comedones  are 
brought  to  view,  and  then  removed.  Lastly  mas- 
sage of  the  surface  using  the  ball  with  salicylicated 
cocoa  oil  or  sulphur  ointment.  (T.  98.)  For  hasten- 
ing the  disappearance  of  scales  which  follow  severer 
types  of  the  disease,  massage  is  one  of  the  best  reme- 
dies ;  the  following  ointment  is  also  highly  recom- 
mended for  the  same  purpose : 


16     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

^.    Hydrarg.  Prsecipit.  Albse,  33 

Bismuth.  Subnit.,  Qiiss. 

Ung.  Glycerini,  ^x. 

M.  (B.  H.) 

Eichoff's  Sulphur,  Camphor,  or  Balsam  Peru 
Soaps  may  be  used  as  an  ordinary  soap  in  mild 
cases,  or  well  rubbed  on  in  severe.     (T.  96.) 

Sea  Baths,  Hygiene,  and  Exercise  are  of  great 
importance.     (Ga.) 

The  springs  of  Richfield,  Sharon,  and  White  Sul- 
phur and  others  of  a  similar  nature  have  a  reputa- 
tion for  beneficial  effects  in  this  affection. 


ACNE   ROSACEA. 

Treatment  will  depend  upon  the  stage  of  the  dis- 
ease and  the  cause  in  each  case. 

Sulphur,  Resorcin,  Naphthol,  Green  Soap,  Sali- 
cylic Acid  and  Ichthyol  as  used  in  acne  simplex, 
are  applicable  especially  in  the  earlier  stages ;  hyper- 
aemia,  small  papules  and  pustules  will  usually  disap- 
pear under  this  treatment .     ( Brocq . ) 

In  the  first  stage  soothing  remedies  are  indicated, 
viz: 

^.    zinc.  Carbonat.  3J. 

Pulv.  Marant.,  3J. 

Hydrarg.  Ammoiiiat.,  gr  x. 

Ung.  Simplicis,  ^j. 
M. 

Or, 
9(.    Plumb.  Acetat., 

Zinc.  Acetat.,  aa  gr.  x. 

Aq.  Rosae,  ^i. 

M. 

Sig. — Apply  with  a  piece  of  old  linen,  for  an  hour  or  two,  night 
and  morning.     (Sh.) 


ACNE   ROSACEA.  17 

Hydrarg.  Bichlorid.:— Gr.  ^-ij,  alcohol  .Ij,  or  an 
ointment.     (Vn.) 

In  the  second  stage : 

Hydrarg.  Ammoniat.:— Gives  good  results;  use  20 
to  25  grains  to  ung.  aq.  rosae,  1  ounce,     (Sh.) 

Sulphur : — Will  be  found  one  of  the  best  applica- 
tions. Ylemingckx's  solution  (B.  H.),  or  an  oint- 
ment of  1  to  2  drachms  to  1  ounce  of  ung.  aq.  rosae 
may  be  used.  Kummerfield's  lotion  (see  Acne  Sim- 
plex) also  forms  an  effective  remedy;  it  may  be  ap- 
plied from  once  to  several  times  a  day.  If  a  sensa- 
tion of  drawing  is  caused  the  preceding  ointment  of 
sulphur  ma3'  be  applied  in  small  quantities  after 
using  the  lotion.     (Vn.) 

Ichthyol: — More  effective  here  than  in  simple  acne. 
It  may  be  used  in  ointments,  lotions,  or  salves,  in  the 
strength  of  5  to  10  per  cent.,  and  in  most  cases  is 
said  to  be  all  that  is  required.  Unna  recommends 
equal  parts  of  ammon.  sulpho-ichthyolate,  distilled 
v^ater,  and  glycerine. 

He  also  makes  use  of  the  following  varnish  : 

Ichthyol,  40  parts. 

Starch,  40  parts. 

Solution  of  Albumen,  i-i}^  parts. 

Water,  sufficient  to  make,  100  parts. 

The  varnish  is  brushed  on  at  night  and  dries 
quickly.  In  the  morning  it  can  be  easily  removed 
b}-^  washing.     (Sh.) 

Ergot. : — Forms  an  effective  application,  viz : 

9^.    01.  Ergot., 

Glycerini,  aa  ^ss. 

Ext.  Belladonnae,  ,5J. 

M.  (Sh.) 

Iodine  : — Kaposi  recommends  the  following  for  ap- 
3 


18  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

plication  eight  to  twelve  times  daily  for  three  or  fotir 
days,  the  part  to  be  immediately  covered  with  gutta 
perch a : 

ifc.     lodi  Pur., 

Potass.  lodid.,  aa  3J. 

Glycerini,  3J-iJ- 

M. 

Among  other  remedies  used  are  Mercuric  and  Sali- 
cylic Acid  Plasters,  Chrysarobin  3  per  cent,  in  liquid 
gutta  percha,  Goulard's  Cerate,  solutions  of  Zinc 
Sulphate,  or  of  Alum,  Pyrogallic  Acid,  Iodized 
Glycerine,  etc. 

Poultices  :  —  Sometimes  when  other  means  have 
failed  hot  fomentations,  followed  by  soothing  appli- 
cations, such  as  oleate  of  bismuth,  are  beneficial. 
(Sh.) 

Puncture  of  the  Skin  : — This  measure  practiced  by 
using  fine  needles  or  a  knife  and  followed  by  spong- 
ing in  hot  water  v^ill  relieve  the  congestion  in  chronic 
stages  of  the  disease.  The  procedure  may  be  re- 
peated at  intervals  of  five  to  seven  days.  After 
each  operation  bland  astringent  applications  should 
be  made.     (Sh.) 

Scarification:— When  the  dilated  bloodvessels  are 
very  prominent,  and  the  tissues  hypertrophied,  linear 
scarification  may  be  performed,  using  a  small  bis- 
toury or  a  Vidal's  scarifier.  A  large  number  of  sit- 
tings are  frequently  necessary.  Local  anaesthesia 
may  be  produced  by  freezing.  The  bleeding  after 
operating  may  be  controlled  by  cold  compresses. 
Scarification  is  advised  as  promising  a  greater  degree 
of  success  than  any  other  method.     (Vn.) 

Electrolysis : — Recommended  b}-  Hardaway  under 
conditions  which  indicate  scarification,  using  a  fine 
needle  attached  to  the  positive  pole  while  the  patient 


ADENITIS.  19 

grasps  the  negative.  Better  results,  however,  are 
obtained  from  the  positive  pole.  A  few  sittings  will 
cause  shrinkage  of  the  vessels.  A  mild  current  is 
used,  and  the  pain  is  trifling.  Scars  rarely  result. 
(B.  H.) 


ADENITIS. 

ACUTE  ADENITIS. 

The  first  indication  of  treatment  is  the  removal  of 
any  source  of  irritation  or  infection.  Any  wound, 
abrasion,  opening,  or  natural  cavity  with  which  the 
involved  gland  connects  should  receive  strict  local 
antisepsis.  The  part  should  be  placed  at  rest  and 
free  from  local  irritation. 

Carbolic  Acid : — Injection  of  10  minims  of  a  3  per 
cent,  solution  into  the  substance  of  the  gland  has 
proved  satisfactory  in  some  instances.     (Saj.) 

Incision  : — When  it  is  necessary  to  open  the  gland 
the  incision  should  be  free,  extending  through  its 
entire  length  in  order  to  facilitate  the  evacuation  of 
its  contents.  The  cavity  should  be  curetted  with  the 
sharp  curette  and  packed  with  iodoform,  camphor- 
ated naphthol,  or  salol  gauze.     (Saj.) 

For  further  details  of  local  antisepsis,  irrigating 
solutions  and  dressings  see  Acute  Abscess. 

CHRONIC  ADENITIS. 

Under  this  head  are  included  glandular  enlarge- 
ments of  a  more  or  less  chronic  and  subacute  type 
which  have  not  gone  on  to  a  suppurative  process. 
In  these  cases  usually  the  disease  is  limited  to  one  or 


20     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

two  glands,  and  is  generalh^  associated  with  some 
external  lesion ;  when  tuberculous  the  entire  mass  is 
involved.  General  hygiene,  sea  bathing  and  sea  air 
for  about  two  months  followed  by  a  sojourn  in  the 
mountains  will  prove  of  great  benefit.  The  follow- 
ing applications  will  be  found  of  service  : 

Iodine  : — The  tincture  is  useful  and  often  effective; 
it  should  be  painted  around  rather  than  on  the 
gland.     (F.) 

Belladonna : — The  officinal  ointment  alone  or  com- 
bined with  officinal  Iodine  Ointment,  equal  parts,  or 
with  equal  parts  of  Iodide  of  Lead  Ointment.  Com- 
bination appears  to  increase  its  efficac3^ 

Cadmium  Iodide  :— May  be  substituted  for  iodine, 
using  1  drachm  to  1  ounce  of  lanolin ;  it  does  not 
stain  the  skin  but  is  not  so  effective. 

Lead  Iodide  : — The  officinal  ointment  rubbed  in 
twice  dailj',  in  non-suppurating  forms,  does  not  pro- 
duce so  much  cutaneous  irritation  as  other  iodine 
preparations.     (Al.) 

Ichthyol  : — 10  to  60  per  cent,  applications  give 
good  results  and  relieve  pain.     (F.) 

Mercurial  Ointment : — For  local  indurations  and 
enlargements,  especially  those  of  bubo  and  lym- 
phatic glands.  It  is  usually  applied  by  inunction,  the 
compound  ointment  containing  camphor,  which  is 
thought  to  promote  the  absorption  of  mercury,  may 
be  preferred.    (F.) 

Mercurial  Plaster  : — Applied  over  enlarged  glands 
for  its  resolvent  action.     (F.) 

Phytolacca  Decandra : — The  solid  extract  spread 
on  a  cloth  is  used  to  prevent  the  formation  of  pus. 
(F.) 


TUBERCULOUS  ADENITIS.  21 

TUBERCULOUS  ADENITIS. 

The  general  line  of  treatment  as  recommended  for 
cold  abscess  is  here  indicated  ;  the  reader  therefore  is 
referred  to  that  subject  in  addition  to  the  following : 

lodol : — A  substitute  for  iodoform,  non-odorous, 
but  less  effective  ;  has  given  good  results  in  suppurat- 
ing adenitis.  After  scraping,  it  may  be  employed  in 
the  form  of  powder  or  solution.  Mazzoni's  formula 
for  the  latter  is  iodol,  1  part ;  alcohol,  14  parts  ; 
glycerine,  32  parts.     (Al.) 

Formalin  : — Injections  are  recommended  in  tuber- 
culous abscesses.  The  treatment  consists  in  withdraw- 
ing the  pus  by  aspiration  with  a  syringe  and  then  in- 
jecting a  solution  of  boric  acid,  which  is  afterwards 
removed  bj^  a  second  aspiration.  A  quantity  of  1  per 
cent,  formalin -glycerine  is  then  injected.  After  the 
operation,  fever  generally  sets  in,  the  fluid  in  the 
abscess  increases  considerably  and  severe  pain  is  felt. 
These  symptoms  subside  after  a  few  days  and  in  a 
fortnight  the  exudation  is  as  a  rule  absorbed.  A 
second  or  even  a  third  injection  of  formalin  may 
have  to  be  given,  although  absorption  often  occurs 
after  the  first  injection.  Recovery  takes  place  in  a 
short  time.     (L.  9,  9,  99.) 

Teucrium  Scordium: — An  aqueous  extract  called 
Teucrin  is  furnished  in  hermetically  sealed  tubes, 
each  containing  45  grains  for  use  bj^  injection.  This 
is  injected  around  the  tuberculous  gland,  the  contents 
of  the  tube  being  used.  The  remed3'  will  setup  an 
inflammatory  action  around  the  gland,  and  bring 
about  the  expulsion  of  the  tuberculous  deposit.  It  has 
been  used  extensively  by  Prof.  Von  Moisteg-Moorhof . 
(F.) 


22  DIGEST   OF   EXTERNAL    THERAPEUTICS. 

Zinc  Chloride  Injections: — 2  to  5  drops  of  a  10  per 
cent,  solution  excites  a  growth  of  fibrous  tissue 
which  encapsulates  the  diseased  portion.  The  injec- 
tions maj^  be  repeated.     (B.  M.,  Vol.  5,  91.) 

Extirpation  : — This  radical  measure  should  be  re- 
sorted to  when  internal  medication  has  failed  ;  when 
the  gland  involves  the  face  producing  deformity; 
when  it  is  isolated ;  when  the  number  of  glands  in- 
volved are  few;  when  it  has  undergone  fibrous 
degeneration ;  and  when  not  freely  suppurating. 

The  contra-indications  are:  Impaired  general 
health,  tuberculous  deposit  in  the  lungs  and  joints, 
and  when  the  ramifications  of  the  glandular  chains 
are  extensive ;  also,  when  many  are  involved,  when 
suppuration  has  commenced  or  peri-adenitis  is  pres- 
ent this  measure  is  not  recommended.     (Saj.) 

Carious  Teeth: — In  children  have  been  found  to  be 
a  medium  by  which  tuberculous  bacilli  can  gain  an 
entrance  and  affect  the  cervical  and  submaxillary 
glands ;  from  this  it  follows  that  such  teeth  should 
be  extracted  or  filled.     (T.  98.) 


AGALACTIA. 

Castor  Oil : — A  strong  decoction  of  the  leaves  ap- 
plied by  means  of  a  soft  cloth  often  proves  successful. 
A  handful  of  the  leaves  may  be  steeped  in  3  to  4 
quarts  of  boiling  water ;  the  breast  should  then  be 
bathed  for  fifteen  to  twenty  minutes;  after  that 
spread  on  over  the  part  a  third  layer  of  the  steeped 
leaves  and  allow  them  to  remain  on  until  dry.  This 
procedure  may  be  repeated.     (Saj.) 

Irritation  of  Gland : — Draw  out  the  milk  with  pump. 


ALOPECIA.  23 

Hot  Applications  : — Decoction  of  Marsh  Mallow  or 
Broom.     (Bt.) 

Electricity : — A  mild  current  of  from  3  to  5  milli- 
amperes  may  be  employed.  The  sponges  of  the 
electrodes  should  be  wet  with  salt  water  and  applied 
on  each  side  of  the  gland,  changing  the  position 
everj'-  few  moments  so  that  all  the  acini  may  be 
traversed  by  the  current  during  a  sitting  of  ten 
minutes.     (Saj.) 


ALOPECIA. 

Local  stimulation  constitutes  the  general  plan  of 
treatment.  If  the  scalp  is  dry  applications  should  be 
made  up  with  oil,  if  greasy,  with  alcohol. 

Spts.  Sapo.  Vir.: — (Sapo.  vir.  ^iv — alcohol,  3ij)  May 
be  used  once  or  twice  a  week  for  shampooing ;  this 
removes  accumulations  of  sebum  and  scales,  and 
stimulates  the  scalp;  after  its  application,  thor- 
oughly dry  the  scalp  and  apply  the  following : 

$1.    Acid.  Carbolic,  gr.  xv. 

Glycerini,   .  jij. 

Aq.  Coloniensis,  ad    ^j. 
M. 

This  may  be  applied  by  means  of  a  comb  and 
Barnes'  dropper,  rubbing  in  well  with  a  soft  brush. 
Go  over  the  scalp  in  a  line  carefully  to  avoid  making 
a  disagreeable  mass,  which  such  application  will  do 
if  rubbed  in  carelessly.     (Vn.) 

Pilocarpine : — This  drug  seems  to  have  an  action  in 
promoting  growth  of  the  hair.  The  following  prep- 
arations are  recommended : 


24  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

9i.    Pilocarpin.  Nitrat.,  gr.  ij. 

Quin.  Hydrochlor.,  gr.  viij. 

Glycerini,  gij. 

Aq.  Rosse,  3yj. 
M.  (M.  W.) 

Lassar's  ointment,  gr.  xv— 5J  (T.  97) ;  or  made  up 
as  follows : 

?t.    Pilocarpin.  hydrochlor.,  3ss. 

Vaselini,  3  v. 

Lanolini,  ^ij. 

01.  Lavandulae,  gtt.  xxv. 

M.  (Ja.) 

Cantharides  : — This  remedy  enters  largely  into  the 
formation  of  "  hair  tonics,"  though  it  is  claimed  that 
their  effect  is  not  increased  by  its  presence.  It  is 
none  the  less  mentioned  by  most  dermatologists  and 
is  usualh'  applied  in  the  proportion  of  Ito  3  drachms 
to  the  ounce. 

Acetic  Acid  : — Has  some  influence ;  it  may  be  used 
in  Cottle's  formula,  viz: 


M. 


P. 


Acid.  Acetici, 

Sss. 

Pulv.  Boraci, 

3J. 

Glycerini, 

3"j- 

Spts.  Vin.  Rect., 

Sss. 

Aq.  Rosae, 

ad     o^^j- 

(B.H.) 

line : — Largely 

used. 

Its 

influence  is  probably 

f  a  local  stimulant. 

Bulkley  recommends : 

Quin.  Sulph., 

9j. 

Zinc.  Sulphat., 

gr.  X. 

Tr.  Cantharidis, 

3"j- 

Alcohol.  Absolut., 

Glycerini, 

aa     5iv. 

Spts.  Myrciae, 

ad     5vj 

M.  (Al.) 


ALOPECIA.  25 

Another  formula  (Gerhard's)  is  the  following  : 

¥».    Quin.  Sulph.,  3ss. 

Tr.  Cantharidis,  3J- 

Spts.  Ammon.  Aromat.,  3J- 

01.  Rosmarini,  gtt.  v. 

Spts.  Myrcise,  Jvss. 

01.  Ricini,  5*ss. 

M 

Sig. — Apply  with  a  stiff  brush  two  or  three  times  a  day.  (Sn. ) 
Liq.  Ammoniae  : — The  following  was  a  favorite  of 
Wilson : 

^.    Ol.  Amj-gdalae, 

Liq.  Ammoniae,  aa     3J- 

Spts.  Rosmarini, 

Aq.  Mellis,  aa    giij. 

M.  (Wa.) 

Medicated  Soaps: — EichofTs  Salicylic  Acid,  Sul- 
phur, Resorcin  and  Tar,  useful  for  shampooing, 
(Vn.) 

Resorcin: — When  there  is  much  scaliness  Rohe  first 
washes  the  scalp  with  tar  soap,  and  applies  a  solu- 
tion of  30  to  60  grains  to  13  ounces  of  spts.  mvrcia. 
Brocq  recommends  the  following  methods  of  using 
this  remed3^  in  alopecia : 

$k.    Resorcini,  gr.  iss. 

Quin.  Hydrochlorat,  gr.  iij. 

Vaselini  Pur.,  5j. 

M. 

This  is  to  be  applied  to  that  part  of  the  scalp 
which  is  devoid  of  hair,  or  from  which  the  hair  is 
rapidly  falling.  If  the  falling  of  the  hair  persists,  it 
is  well  to  incorporate  with  it  5  to  15  minims  of  tinc- 
ture of  cantharides,  or  use  the  following : 

9:.    Resorcini,  gr.  iij. 

Quin.  Hydrochlorat.,  gr.  v. 

Sulphur.  Praecipitat. ,  gr.  xxx. 

Vaselini  Pur.,  ^j. 
M. 


26     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Should  these  preparations  produce  much  irritation 
of  the  scalp,  an  ointment  composed  of  20  grains  of 
borax  to  100  of  vaseline  should  be  applied.  After 
the  irritation  is  relieved,  weaker  preparations  of  re- 
sorcin  and  quinine  can  be  emplo^'cd,  of  which  the  fol- 
lowing is  an  example : 

?fc.    Acid.  Salicylic,  gr.  v. 

Resorcini,  gr.  iij. 

Quin.  Hydrochlorat.,  gr.  v. 

Sulphur.  Precipitat.,  gr.  xxx. 

Vaselini  Pur.,  ^j. 
M. 

Should  the  falling  of  the  hair  be  associated  with 
seborrhoeic  eczema,  a  mercurial  ointment,  such  as 
that  of  3^ellow  oxide  of  mercurx',  var^ang  in  strength 
from  1—25  to  1-10,  according  to  the  severit3^  of  the 
trouble,  should  be  used.  This  is  onh^  to  be  rub- 
bed upon  isolated  patches  at  a  time.  After  it  has 
been  employed  and  an  alterative  effect  upon  the  skin 
produced,  resorcin  may  be  resorted  to : 

9;.    Resorcini,  gr.  iv. 

Acid.  Salicylic,  gr.  vij. 

Vaselini  Pur.,  ^j. 

M. 

When  the  scalp  is  excessiveh'  greasy,  the  ointment 
previously  employed  and  the  natural  oil  of  the  skin 
should  be  removed  by  washing  the  scalp  with  a 
weak  solution  of  ammonium  acetate  or  b^-  using 
castile  soap  and  warm  \vater.  Under  no  circum- 
stances should  the  oilj'  preparations  be  used  con- 
tinuously without  occasional  cleansing  of  the  scalp. 
(P.  M.J^,  4,  22,  99.) 

Lassar  recommends  the  following  method :  First 
wash  the  scalp  with  tar  soap,  then  rub  in  well  a  2 
per  cent,   solution  of  Corrosive  Sublimate;  this  is 


ALOPECIA   AREATA.  27 

followed  b^-  the  application  of  Naphthol  1  to  3  per 
cent,  in  alcohol  to  dry  the  hair :  the  scalp  is  finally 
anointed  with  a   2   per  cent,  solution  of  Salicylic 
Acid  in  ohve  oil. 
For  use  after  fevers,  the  following : 

p.    Sodii  Biborat..  gr.  xsdv. 

Acidi.  Salicvlic,  gr.  viij. 

Tr.  Cantharidis,  Jij. 
Spts.  Myrciae, 

Aq.  Rosae,  aa    Sj. 

Aq.  Bullientis,  ad    ^x. 

(Vn.) 

Sulphur : — 1  drachm  to  the  ounce  in  cold  cream,  a]> 
cohol  or  vasehne,  constitutes  one  of  the  best  reme- 
dies when  pityriasis  or  seborrhoea  sicca  is  the  cause. 
(B.  H.) 

Tr.  Capsici,  .xj-iij-^j ;  Chloral,  5J-5J ;  Tr.  Nux  vom., 
5J-5J;  Hydrag.  Bichlorid.,  1-500,  are  other  stimu- 
lants in  use.     (B.  H.) 

Many  cases  do  better  under  an  antiparisitic  treat- 
ment. Antiparasitic  Soaps  should  also  be  considered. 

(Pf.) 

Borax  : — Is  useful  for  cleansing,  but  its  continuous 
employment  is  injurious.     Qa.) 

Yolk  of  Egg  beaten  up  in  Lime  Water  forms  an 
excellent  shampoo.  Brushing  the  hair  vigorously  in 
reverse  direction  to  that  in  which  it  lies  is  beneficial. 
(Rd.) 


ALOPECIA  AREATA. 

Treatment  is  regarded  bv  some  dermatologists  as 
inefiiectual,  either  for  restoring  the  growth  of  hair  or 
for  preventing  the  formation  of  new  patches  (Ka- 


28  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

posi);  many  writers,  on  the  other  hand,  Avhile  not 
claiming  very  satisfactory^  results,  advise  the  per- 
sistent employment  of  remedies.  Local  treatment 
should  be  directed  tov^^ard  stimulation  of  the  skin. 
Before  application  the  scalp  should  be  well  washed 
wath  castile  soap  or  Avith  spirits  of  green  soap. 

Capsicum  and  Cantharides  : — The  following  is  a 
useful  combination : 

Jfc.    Tr.  Cantharidis, 

Tr.  Capsici,  aa  gss. 

Ol.  Ricini,  gss. 

Aq.  Coloniensis,  ^j. 

M.  (Vn.) 

A  formula  of  Tilbury  Fox,  which  Van  Harlingen 
says  he  has  used  w^ith  satisfaction,  is : 

1^.    Tr.  Nucis  Vom.,  ^ss. 

Tr.  Cantharidis,  3vj. 

Glycerini,  ^ij. 

Aq.  Destill.,  ^iss. 

Aq.  Rosae,  ^iij- 

M. 

Carbolic  Acid : — A  95  per  cent,  solution  brushed 
lightly  with  a  sw^ab  over  the  affected  part  and  then 
rubbed  in  is  highh^  recommended  by  Bulkley. 

Tricresol: — This  remedy  is  credited  with  produc- 
ing a  growth  of  hair  on  the  denuded  patches  in  from 
one  and  a  half  to  two  and  a  half  months.  It  is  pre- 
eminently an  antiseptic  and  disinfectant,  containing 
the  ortho-,  meta-,  and  para-cresols  in  a  pure  state, 
and  alwaj-^s  of  uniform  100  per  cent,  strength.  It  is 
a  clear,  v^hite,  watery  liquid,  having  three  times  the 
disinfectant  value  of  carbolic  acid,  w^hile  it  is  three 
times  less  poisonous,  and  less  caustic.  It  has  been 
used  successfully  in  a  number  of  cases  applied  in  the 
foUow^ing  manner : 


ALOPECIA   AREATA.  29 

The  patch  is  thoroughly  cleansed  with  benzine, 
and  the  remedy  applied  pure  to  the  scalp  and  in  50 
per  cent,  dilution  with  alcohol  to  the  face,  with  or 
without  epilation.  It  is  well  rubbed  into  the  de- 
nuded patches  and  into  the  roots  of  the  hairs  for  half 
an  inch  around  b3^  means  of  a  small  swab  on  a 
holder.  The  immediate  burning  pain  is  readily- 
borne,  and  passes  away  in  a  short  time.  The  skin 
turns  white,  and  the  hair  and  sebaceous  follicles 
come  plainW  into  view,  seeming  to  gape.  In  a  few- 
hours  there  is  a  circumscribed  hyperasmia;  on  the 
scalp  there  occurs  a  very  slight  transudation  of 
serum,  and  on  the  face  there  is  occasionalh'-  vesicula- 
tion.  Within  twenty-four  hours  there  forms  a  drj'-, 
brow^nish-red  scale,  which  falls  off  in  four  to  ten 
days,  when  a  new  application  is  required.  Slight 
tenderness  is  left  behind,  and  the  second  application 
should  be  less  vigorous ;  but  there  is  never  sloughing 
or  scar  formation. 

The  remedj^  has  been  applied  in  most  cases  txery 
five  days,  in  some  once  a  week.     (J.  C.  G.,  5,  99.) 

The  following  course  of  treatment  is  that  of  Balzer : 

(1)  Render  the  scalp  aseptic  by  applying  Van 
Swieten's  Liquor,  pure  or  diluted  one  half.  This 
may  also  be  continued  for  a  time  after  apparent 
cure. 

(2)  Every  morning  apply,  after  using  the  above, 
the  following  {Lotio  Excitante  de  St.  Louis): 


Camphorated  Alcohol, 

125  parts. 

Ess.  Turpentine, 

5     " 

Liq.  Ammonia, 

I  part. 

(3)  At  night  the  following: 


30  DIGEST   OF   EXTERNAL   THERAPEUTICS. 


Yellow  Oxide  of  Mercury, 

2  parts. 

Flowers  of  Sulphur, 

4     " 

Oil  of  Cade, 

15     " 

Vaseline, 

30     '« 

(T.,  99.) 

Hydrarg.  Bichlorid.: — This  remedy  enters  into  the 
formation  of  man3^  lotions ;  it  may  be  used  in  solu- 
tion of  2  to  3  grains  to  the  ounce,  or  in  combination 
wnth  other  drugs.  It  forms  one  of  the  principal  in- 
gredients in  the  method  recommended  by  Raj^mond, 
who  promised  to  restore  the  hair  in  sixty  days  by 
adopting  the  following :  The  surface  of  the  denuded 
patch  is  first  washed  with  carbolic  soap,  and  the 
periphery  shaved.  This  should  be  done  twice  a  w^eek ; 
then  every  morning  the  following  wash  is  rubbed  in 
with  a  paint  brush  for  one  or  two  minutes : 

^.    Hydrarg.  Bichloridi,  gr.  vijss. 

Tr.  Cantharidis,  3vj. 

Bal.  Fioravanti,  ^iss. 

Aq.  Coloniensis,  ^v. 
M. 

At  night  the  following  solution  is  to  be  used  in  the 
same  w^ay : 

9;.    Acid.  Salicylici,  3ss. 

Naphtholi,  giiss. 

Acid.  Acetici  (crys. ),  ^  ss. 

01.  Ricini,  ^iiiss. 
M.  (B.  H.) 

Subcutaneous  administration  of  the  bichloride  has 
been  successfully  employed  by  Motj' ;  he  used  a  4  per 
cent,  solution  in  water,  w^ith  2  per  cent,  of  cocaine 
added.  Of  this  a  single  injection  of  one  drop  was 
made  in  a  medium  sized  patch,  and  from  four  to  five 
about  a  large  patch  and  at  its  periphery.  There 
should  be  interv'als  of  four  days  between  the  injec- 


ALOPECA   AREATA.  31 

tions.  A  cure  is  said  to  be  expected  after  the  fourth 
series  of  injections.     (Ja.) 

Pilocarpine  : — Ointment,  gr.  xv— §j. 

Acetic  Acid : — Paint  the  spots  until  they  whiten, 
then  sponge  with  cold  water;  repeat  three  or  four 
times  a  day.     (Ja.) 

The  acetic  acid  lotion  of  Besnier  is  as  follows : 

^.    Acid.  Acetic.  Crys.,  gr.  xv.   . 

Chloral.  Hydrat.,  3J. 

Ether.  Sulphuric,  ^viiss. 
M.  (T.,99.) 

Ammonia: — The  following  was  recommended  by 
Sir  Erasmus  Wilson : 

9^.    L,iq.  Ammonige  Fort., 

01.  Amygdalae  Dulcis,  aa  ^  ss. 

or.  I/imonis,  ^ss. 

Spts.  Rosmarini,  ad.  §iv. 

M. 

Also  the  following  applied  with  friction : 

9:.    Tr.  Aconiti  Rad.,  giv. 

Chloroformi,  gij. 

Liq.  Ammoniae,  3J. 

Pulv.  Camphorsb,  ^j. 

01.  Olivse,  ad.  |ij. 
M.  (Vn.) 

Cantharidal  Collodion:  —  Blisters  are  sometimes 
used  with  success,  and  are  mentioned  by  many  der- 
matologists. Crocker,  after  blistering  recent  patches, 
directs  that  the  loose  hair  about  the  patches  be 
pulled  out,  and  the  following  ointment  rubbed  in : 

1^.    Chrysarobin.,  3ss-j. 

I,anolin.,  ^j. 

01.  Olivae,  q.  s. 
M. 

Some  of  the  numerous  remedies  are  as  follow^s : 
Chrysarobin  : — 3  to  12  per  cent,  ointment  (caution 


32  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

about  getting  any  into  the  eyes).  (B.  H.)  Oleate  of 
Mercury  : — 2  to  10  per  cent.  Iodine  : — The  tincture 
painted  on  patches,  has  been  followed  by  growth  of 
hair;  a  33%  per  cent,  solution  in  collodion  is  also 
used.    (Ja.) 


.     ALOPECIA  SYPHILITICA. 

As  the  hair  w^ill  return  under  constitutional  treat- 
ment local  measures,  as  a  rule,  are  of  little  import- 
ance ;  if  their  use,  however,  is  deemed  expedient,  the 
preparations  mentioned,  in  preceding  paragraphs, 
especially  those  containing  Bichloride  of  Mercury, 
may  be  employed. 


AMENORRHCEA. 

Hot  Sitz  Baths: — For  six  days  previous  to  the 
periods  or  at  the  time  of  the  period,  mustard  may  be 
added.     (R.) 

Cold  Sitz  Baths  : — Administered  as  follows :  Place 
the  patient  in  a  bath  tub  with  water  at  58°,  keeping 
the  feet  and  legs  warm  and  shoulders  covered ;  after 
the  bath  the  patient  should  be  well  rubbed  and 
placed  in  bed.  These  baths  should  be  used  only  in 
functional  varieties.     (Ga.) 

Spinal  Ice  Bag: — Applied  to  low^er  dorsal  and  lum- 
bar vertebrae ;  useful  in  some  cases.     (R. ) 

^A^arm  W^ater  Douches: — These  are  useful,  but 
should  not  be  too  hot  lest  they  produce  anaemia. 
(T.,  99.) 


ANESTHESIA.  33 

Electricity : — One  of  the  most  reliable  emmena- 
gogues.  Use  either  the  faradic  or  galvanic  current, 
the  former  should  be  tried  first.  The  primary  fara- 
dic current  is  applied  as  follows :  Negative  pole  in  the 
uterus,  positive  pole  externally  to  abdomen ;  seance 
to  last  fifteen  minutes.  Galvanism  may  be  used  if 
faradism  fails.  Electricity  is  especially  useful  for 
long-standing  cases  which  have  resisted  all  other 
treatment,  and  in  those  cases  where  the  parts  are 
poorh"-  developed  or  atrophied  from  superinvolution 
or  chronic  metritis.     (K.  C.) 

Gymnastics,  Sea  Bathing  and  Saline  Spring  Baths, 
Friction  along  the  Spine  and  Massage  are  other  ser- 
viceable remedial  measures. 


ANAESTHESIA. 

Chronic  alcoholism,  emphysema,  and  fatty  degen- 
eration of  the  heart  are  peculiarly  unfavorable  condi- 
tions for  the  administration  of  aneesthetics.  More 
disasters  arise  from  the  latter  cause  than  from  any 
other.  Tumors  and  abscess  of  brain  are  also  danger- 
ous. Very  much  enlarged  tonsils,  swollen  epiglottis 
and  oedema  of  the  glottis,  are  contra-indications, 
but  not  insuperable.  No  operation,  however  slight, 
should  be  undertaken  until  anaesthesia  is  complete. 
Enfeebled  persons  often  bear  anaesthesia  better  than 
the  robust,  women  and  children  better  than  men.  It 
is  generally  safer  Avhen  given  for  an  operation  in  dis- 
ease than  for  injury.  Administration  should  always 
be  on  an  empty  stomach.  At  first  the  anaesthetic 
should  be  given  slowly.  Before  administering,  an 
4 


34     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

ounce  or  two  of  whiskey  or  brandy  is  recommended 
by  some  surgeons. 

Morphia  Subcutaneously  is  advised  by  Bernard  to 
enable  the  inhalation  to  proceed  more  quietly.  The 
quantity  of  the  anaesthetic  required  is  much  less,  and 
the  stage  of  insensibility  more  prolonged  when  the 
drug  is  thus  given.  It  is  also  claimed  that  it  has  the 
property  of  antagonizing  the  paralj'zing  action  of 
the  anaesthetic  on  the  cardiac  and  respiratory  centres 
and  therebj'  prevents  shock.  Man}-  surgeons  prefer 
giving  morphia  subcutaneously  after  the  operation 
before  recover)^  of  consciousness;  this  is  especially 
desirable  in  operations  in  w^hich  the  after  effects  are 
painful.     (B.) 

Chloroform:  —  This  anaesthetic  is  attended  with 
more  danger  than  ether,  but  produces  less  gastric 
disturbance.  It  is  less  disagreeable,  and  not  inflam- 
mable, and  is  therefore  better  adapted  for  adminis- 
tration at  night.  Its  action  is  also  more  prompt 
and  the  narcosis  induced  by  it  more  sustained, 
but  these  advantages  are  overcome  by  the  greater 
freedom  from  danger  Avhich  ether  possesses.  Its  use, 
as  a  rule,  when  ether  is  available  is  not  justifiable. 
It  should  be  preferred,  however,  in  obsterics,  because 
of  its  prompt  action,  comparative  agreeableness  and 
non-inflammability.  It  has  been  shown  to  be  safe  in 
labor  wrhen  properly  administered.  (B.)  The  respi- 
ration, countenance  and  pulse  should  alwaj's  be  care- 
fully watched.  The  well  known  A.  C.  E.  mixture, 
much  used  in  England,  consists  of  Alcohol  (95  per 
cent.)  1  part,  Chloroform  2  parts,  Sulphuric  Ether 
3  parts,  made  up  fresh  as  required.     (Ga.) 

Ether : — This  agent  should  always  be  preferred  as 
an  anaesthetic.    Administration  should  proceed  at 


ANESTHESIA.  35 

first  slowly,  and  the  drug  should  not  be  crowded. 
The  pulse,  temperature  and  countenance  should  be 
carefully  watched.  A  period  of  eight  to  twelve  hours 
fasting  should  always  precede  its  use. 

Mr.  George  Rowell,  of  Guys'  Hospital,  regards  the 
A.  C.  E.  mixture  dropped  upon  Skinner's  mask,  fol- 
lowed by  1/^  to  2  drachms  of  ether  upon  the  sponge  of 
Renale's  inhaler  and  1  to  3  drachms  of  ether  then 
substituted  for  the  first  anjesthetic,  as  the  safest  and 
best  method  for  routine  practice  in  children.  (T.,  99.) 

Nitrous  Oxide  Gas  : — This  is  a  safe  agent  for  short 
operations,  quickly  executed,  such  as  extraction  of 
teeth,  opening  abscesses,  etc.  It  may  also  be  admin- 
ietered  \vith  excellent  effect  preparatory  to  ether. 
The  patient  is  first  placed  under  the  influence  of  the 
gas,  which  is  then  withdrawn,  and  the  ether  applied. 
This  procedure  obviates  the  unpleasant  effects  of  the 
first  inhalations  of  ether,  often  less  is  required,  and 
the  after  effects  less  disagreeable.  For  those  persons 
who  particularh'  dread  taking  ether,  this  is  to  be 
commended.  Experience  and  care  is  necessary-  for 
this  method  of  administration. 

A  mixture  of  nitrous  oxide  gas  with  10  to  15  per 
cent,  of  oxygen  is  recommended  b3'  Dr.  He\vitt,  who 
has  devised  an  apparatus  for  its  administration. 
Minor  operations  can  be  performed  under  its  influ- 
ence.   (T.,  99.) 

Means  for  Meeting  Dangerous  Symptoms  During 
the  Administration  of  Anaesthetics. 

Remove  the  cone  and  immediately  invert  the  pa- 
tient according  to  Nelaton's  method;  if  respiration 
has  stopped,  apph'  artificial  respiration  by  Silvester's 
method,  forciby  draw  out  the  tongue;   use  faradism 


36  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

to  the  respirator\^  muscles ;  apph'  artificial  warmth 
and  give  amyl  nitrate  inhalations. 

Brandy,  whiskey  and  ether  are  recommended  to  be 
given  hypodermically,  but  some  observers  regard  the 
administration  of  alcohol  and  its  derivatives  in  this 
condition  as  not  onh^  questionable  but  productive  of 
positive  harm.  This  conclusion  does  not  seem  illogi- 
cal since  the  patient  is  already  suffering  from  an 
alcoholic  narcosis. 

When  there  are  evidences  of  sudden  failure  of  the 
heart,  as  indicated  by  feebleness  or  stoppage  of  the 
pulse  and  extreme  pallor,  whiske^^  may  be  injected 
subcutaneoush'  or  hj  enema ;  in  the  latter  instance 
administer  half  a  cupful  -with  an  equal  amount  of 
warm  water.  Hypodermic  injections  of  str\'chnia 
may  also  be  given. 

Oxygen  inhalations  are  of  service  not  only  when 
dangerous  symptoms  are  imminent,  but  also  during 
an  operation,  when  c^'anosis  becomes  marked,  a  few^ 
inhalations  w^ill  then  prove  effective. 

Intravenous  saline  injections  appear  to  have  a 
rational  basis  for  administration,  as  the\'  alter  the 
blood  pressure  and  thereby  stimulate  the  circula- 
tion. 

LOCAL  ANESTHESIA. 

Sprays  of  Ether,  Rhigolene,  or  Ethyl  Chloride  for 
freezing  the  skin. 

The  following  is  to  be  used  as  a  spray,  the  resulting 
anaesthesia  lasts  for  about  five  minutes : 

^.    Chloroformi,  3J. 

Etheris,  3  XV. 

Mentholi,  3J. 
M. 


LOCAL  ANESTHESIA.  37 

Cocaine  : — Solutions  of  4  to  10  per  cent,  are  gener- 
ally successful  on  mucous  surfaces.  In  minor  sur- 
gery, and  in  operations  w^here  the  circulation  can  be 
arrested,  solutions  of  about  4  per  cent.,  subcutane- 
ously,  are  of  great  value.  In  ophthalmology^  this 
agent  is  most  satisfactory,  being  suitable  for  all  op- 
erations on  the  eyeball,  except  iridectomy  for  acute 
glaucoma,  and  enucleation.  In  genito-urinary  sur- 
gery it  must  be  used  with  caution.     (M.  W.) 

It  is  also  valuable  to  render  painless  manipulations 
in  laryngological,  obstetrical,  genito-urinary,  and 
rectal  practice .     ( B . ) 

The  introduction  of  cocaine  through  the  unbroken 
skin  by  means  of  an  electric  current  has  been  success- 
fully employed  by  Dr.  H.  Lewis  Jones  in  certain 
minor  surgical  operations.  For  example,  in  the 
small  electrolytic  operations  necessary  for  the  re- 
moval of  facial  blemishes,  such  as  moles,  superfluous 
hairs,  and  small  capillary  naevi,  this  mode  of  sparing 
the  patient  pain  without  recourse  to  general  anees- 
thesia  is  very  useful.  It  is  much  easier  to  produce  an- 
aesthesia w^ith  a  solution  of  cocaine  in  guaiacol  than 
it  has  been  hitherto  with  watery  solutions.  Jones 
employs  a  solution  of  6  grains  of  cocaine  (not  the 
hydrochlorate)  dissolved  in  a  drachm  of  guaiacol.  If 
a  little  of  this  mixture  upon  a  piece  of  blotting  paper 
be  placed  upon  the  skin  and  a  current  applied  to  it, 
anaesthesia  suflScient  for  the  purposes  indicated  can 
be  produced  in  about  four  or  five  minutes.  The  posi- 
tive electrode  should  be  placed  on  the  blotting  paper. 
It  should  consist  of  a  flat  disc  of  bare  metal  of  suit- 
able size.  Care  must  be  taken  that  the  metal  does 
not  touch  the  skin  at  any  point.  The  current  is  then 
turned  on  until  it  reaches  about  4  milliamperes  for 


3S  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

an  electrode  half  an  inch  in  diameter.  At  first  from 
10  to  15  cells  are  necessary'  to  produce  this  current, 
for  the  solution  has  a  high  resistance,  but  soon  con- 
duction improves  and  the  number  of  cells  may  be 
reduced.  The  action  should  not  be  prolonged  for 
more  than  four  or  five  minutes,  since  the  solution 
itself  is  slightly  caustic.  Common  sensation  ma^^  not 
be  entirely  done  away  with,  but  the  perception  of 
pain  is  so  nearly  abolished  that  the  patient  will  bear 
the  introduction  of  a  needle  with  calmness.  (C.  J., 
3,  8,  99.) 

Tropacocaine  : — A  costU^  drug ;  it  causes  in  the  eye 
neither  ischaemia,  irritation,  nor  hyperemia;  3  per 
cent,  solutions  are  employed.  Compared  to  cocaine 
its  action  is  quicker,  but  more  transitory.  The  ac- 
tion must  be  kept  up  by  adding  a  drop  from  time  to 
time ;  mydriasis  is  slight.  It  may  be  employed  when 
it  is  desired  to  produce  anaesthesia  without  dilata- 
tion of  the  pupil.  No  harmful  effects  have  been  ob- 
served.    (M.  W.) 

Eucaine  Hyderchloride  : — Under  this  name  there 
are  two  salts  which  are  different  in  composition. 
They  are  synthetic  compounds,  allied  to  cocaine. 
Eucaine  Hyderchloride  A  is  used  for  general  local 
anaesthesia.  Eucaine  Hyderchloride  B  is  slower  in 
action  than  cocaine  and  less  active,  possessing  half 
the  strength,  but  anaesthesia  is  more  prolonged,  and 
the  heart  is  not  affected,  nor  the  pupils  dilated.  In 
ophthalmic  practice  a  5  per  cent,  solution  is  effective ; 
for  the  nose  and  throat  an  8  per  cent,  solution. 
(M.  W.) 

Holocaine  Hydrochloride: — Half  the  strength  of 
cocaine ;  as  an  anaesthetic  for  operations  on  the  eye, 
it  allows  more  bleeding,  but  has  no  effect  on  the 


LOCAL    ANESTHESIA.  39 

pupil.  Its  action  is  prompt  and  lasting  without 
mydriasis,  or  disturbance  of  accommodation.  It  is 
not  suitable  for  hypodermic  use  on  account  of  its 
toxic  effects.  (M.  W.)  Recent  investigations  showr 
that  this  drug  has  strongly  marked  antiseptic  quali- 
ties. 

Dr.  J.  Guttman  in  a  series  of  observations  of  the 
effects  of  holocaine  in  about  150  operations  concludes 
that  in  many  instances  it  is  preferable  to  cocaine, 
although  it  cannot  entirely  replace  it.  Both  were 
found  to  paralyze  the  terminal  filaments  of  the  sen- 
sory nerves,  and  the  onset,  duration,  and  intensity 
of  anaesthesia  were  about  the  same  in  both.  Either 
may  be  used  on  the  eye. 

Holocaine  was  found  to  be  preferable  in  the  re- 
moval of  a  foreign  body  from  the  cornea,  as  it  does 
not  produce  subsequent  mydriasis ;  also  in  strabis- 
mus, as  there  is  no  shrinkage  of  the  muscle.  In  in- 
flammatory conditions  with  blepharospasm  it  re- 
lieves the  spasm  and  pain,  and,  as  an  antiseptic,  is 
curative.  On  account  of  the  tendency  of  holocaine  to 
produce  haemorrhage,  cocaine  is  to  be  preferred  wrhen 
there  are  atheromatous  arteries.  The  vaso-con- 
strictor  effect  of  cocaine,  and  the  diminished  tension 
on  the  eyeball,  together  with  the  subsequent  deepen- 
ing of  the  anterior  chamber,  are  all  factors  in  favor  of 
using  it  for  the  performance  of  an  iridectomy  under 
these  conditions.  When  the  pupil  is  small  its  mydri- 
atic action  aids  in  cataract  operations.  The  anti- 
septic action  of  holocaine  and  the  possibility  of 
sterilizing  it  are  alw^ays  in  its  favor.  In  operations 
on  the  throat  and  nose  the  taste  of  cocaine  is 
against  it,  and  the  haemorrhage  following  holocaine, 
on  the  other  hand,  is  against  it,  vvrhile  cocaine  pro- 


40  DIGEST   OF  EXTERNAL  THERAPEUTICS. 

duces  a  shrinkage  not  seen  with  holocaine.  (N.  Y. 
M.J.  6,17,  99.) 

Orthoform  : — A  white  cn^stalUne  powder,  possess- 
ing both  antiseptic  and  anaesthetic  properties.  It  is 
employed  locally,  in  a  saturated  solution,  in  a  10  per 
cent,  aqueous  solution  of  the  hj-drochloride,  in  a 
10-20  per  cent,  ointment  of  the  same  in  lanolin,  in  a 
saturated  solution  in  collodion,  and  as  a  dusting 
powder.  It  is  highh^  commended  for  burns  and 
painful  ulcerations,  and  appears  to  be  non-poison- 
ous, more  than  700  grains  having  been  used  locally 
on  a  cancer  during  the  course  of  a  week.  (L.  II.,  97.) 
As  a  spraj'  for  laryngeal  and  nasal  ulceration  5 
grains  should  be  dissolved  in  50  minims  each  of  rec- 
tified spirits  of  wine  and  water ;  for  insufflation  in 
laryngeal  tuberculosis  3  grains  may  be  administered . 
The  drug  does  not  produce  sufficient  anaesthetic  ef- 
fect to  permit  of  an  operation,  though  it  is  said  to 
render  painless  operations  with  the  uterus.  (B.  M. 
J.,  I.,  98.)     (M.  C,  12,  97.) 

Although  orthoform  is  said  bj^  most  all  observers 
to  be  perfectly  harmless,  Brocq  reports  two  cases 
which  throw  doubts  on  this  statement.  In  one  an 
ointment  of  1-40,  applied  to  the  face,  produced  great 
sw^elling  and  redness  which  lasted  for  nearh'  three 
weeks;  in  another  the  powder  applied  to  fissure  of 
the  vulva  caused  tumefactions  and  nodular  swelling 
in  various  parts  of  the  bod3\     (P.  M.,  4,  15,  99.) 

Anaesthesia  by  Infiltration. 

Cocaine  : — Solutions  of  4  to  5  per  cent,  are  injected 

along  the  seat  of  the  intended  incision ;  this  is  not 

w^ithout  danger,  as  the  drug  necessarily  enters  the 

circulation.    When  the  seat  of  the  incision  is  so  situ- 


LOCAL  ANESTHESIA.  41 

ated  the  part  should  be  ligated  and  thus  cut  off  the 
circulation.    The  wound  should  be  allowed  to  bleed 
before  the  removal  of  the  ligature. 
A  useful  formula  is  as  follows : 


^.    Cocainge  Hydrochlorat., 

gr.  ijss. 

Morphige  Hydrochlorat., 

gr.  Vi. 

Sodii  Chlorid., 

gr-  iij. 

Aq.  Destill., 

giiiss. 

M. 

The  proportion  may  vary  from  one-tenth  the 
quantity  of  cocaine  to  twace  as  much  or  more.  In- 
jections should  be  made  through  the  true  skin  and 
should  be  numerous  enough  to  produce  insensibility 
of  the  surface.  At  the  points  of  injection  wheals 
will  appear.     (B.) 

The  composition  of  Schleich's  Anaesthetic  Salts, 
to  which  reference  is  frequently  made,  is  as  follows : 

According  to  the  Centralhlatt  fiir  die  gesammte 
Therapie  for  October,  1897,  there  are  three  kinds  of 
Schleich's  tablets  on  the  market,  numbered  1,  2,  and 
3,  as  follows : 

1.  Cocaine  Hydrochlorate,  3  grains. 
Morphine  Hydrochlorate,                      0.675  grain. 
Sterilized  Sodium  Chloride,  3  grains. 

To  be  dissolved  in  1,500  grains  of  distilled  water. 

2.  Cocaine  Hydrochlorate,  1.50  grain. 
Morphine  Hydrochlorate,  0.675  grain. 
Sterilized  Sodium  Chloride,  3  grains. 

To  be  dissolved  in  1,500  grains  of  distilled  water. 

3.  Cocaine  Hydrochlorate,  1.50  grain. 
Morphine  Hydrochlorate,  0.075  grain. 
Sterilized  Sodium  Chloride,  3  grains. 

To  be  dissolved  in  1,500  grains  of  distilled  water. 

Eucaine  : — This  has  been  found  to  be  a  better  drug 
than  cocaine  for  infiltration  aneesthesia.  It  is  less 
irritating  and  less  toxic  than  cocaine.     As  it  is  not 


42  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

decomposed  by  boiling  it  admits  of  thorough  sterili- 
zation. The  following  forms  a  stable  solution  which 
can  be  boiled : 

/5-Eucaine,  i  part. 

Sodium  Chloride,  8  parts. 

Distilled  Water,  loo  parts. 
Use  at  temperature  of  body. 

Nirvanin : — As  orthoform  and  new  orthoform  can- 
not be  used  h^^podermically  on  account  of  the  diffi- 
culty -with  wrhich  they  dissolve,  and  as  their  salts  are 
too  irritant  for  that  purpose,  Einhom  and  Heintz 
have  by  processes  of  substitution  produced  a  sub- 
stance, the  hydrochlorate  of  diethAdgh'cocoll-p- 
amido-o-ox3^benzoic-acid-methyl-ester,  which  is  not 
alone  more  permanent  than  cocaine,  but  also  ten 
times  less  toxic.  In  2  per  cent,  solutions,  injected 
hypodermicallj^  it  produces  a  prolonged  regional 
aneesthesia.  It  is  sold  under  the  name  of  nirvanin. 
(M.  M.  W.,  12,  6,  98.) 

This  substance  promises  to  be  of  great  value. 
When  injected  under  the  skin  it  produces  a  small  cir- 
cumscribed wheal  from  w^hich  radiates  a  greater  or 
less  zone  of  anaesthesia,  according  to  the  strength  of 
solution  used.  The  length  of  the  anaesthesia  is  in 
direct  ratio  with  the  strength  of  the  solution,  a  1  per 
cent,  solution  giving  anaesthesia  continuing  about 
five  minutes,  while  a  2  per  cent,  solution  gives  insen- 
sibility for  tw^enty-three  minutes  after  the  injection. 
The  bactericidal  action  of  nirvanin  is  shown  by  the 
fact  that  a  7  per  cent,  solution  injected  v^'ith  bacillus 
pyocyaneus  became  sterile  in  twelve  hours,  a  2  per 
cent,  in  six  hours,  and  a  4  per  cent,  in  three  hours. 
(M.  M.  W.,  1,  3,  99.) 

The  results  of  experiments  which  may  be  summar- 


ANEURISM.  43 

ized  as  follows  show  this  new  angesthetic  to  possess 
the  following  properties:  It  is  one-tenth  less  toxic 
than  cocaine ;  the  maximum  dose  is  .5  grm.  (7%  gr-); 
it  is  a  pow^erful  antiseptic ;  its  effect  is  more  lasting 
than  that  of  cocaine ;  it  is  not  adapted  for  applica- 
tion to  the  mucous  membrane  w^hen  it  is  intended 
anaesthesia  should  be  deep ;  it  is  generally  irritating 
to  the  eye. 

The  greatest  use  for  this  preparation  will  be  on 
account  of  its  non-toxie  and  powerful  antiseptic 
properties,  and  the  complete  and  long  continuation 
of  the  anaeshesia  produced  by  subcutaneous  injec- 
tion.    (M.  M.  W.,  12,  6,  98.)    (T.  P.,  6,  99.) 

Guaiacol : — 1  part  with  10  of  olive  oil  by  subcutan- 
eous injection  have  been  used. 


ANEURISM. 

Rest  is  imperative  and  must  be  absolute.  In  some 
instances  the  recumbent  posture  has  a  favorable 
effect.     (Rd.) 

Galvanic  Puncture: — This  measure  has  been  suc- 
cessful in  a  few  instances.  Ciniselli  reported  twenty- 
three  cases  M^ith  five  cures.  In  the  small  sacculated 
variety  it  may  be  employed  with  some  hope.  First 
introduce  into  the  sac  a  needle  insulated  except  at  its 
point ;  to  this  the  positive  pole  is  attached,  and  the 
negative  to  a  large  electrode  placed  over  the  abdo- 
men. The  current  is  allowed  to  pass  from  three  to 
four  hours.  Before  operating  the  apparatus  should 
be  tested  in  fresh  blood  or  egg  albumen.  Danger 
from  embolism  appears  to  be  slight.  (Gn.)  Another 
method  is  that  of  Loreta ;  two  needles  are  passed 


44  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

into  the  sac,  and  a  mild  current  of  electricity  is  passed 
through,  producing  both  an  electrical  and  mechani- 
cal effect     (Ty.) 

Ergotin : — Injections  of  the  aqueous  extract  were 
first  emplo^^ed  by  Langenbeck;  from  2  to  5  grains 
are  dissolved  in  water  or  glycerine  and  injected  into 
the  region  of  the  sac ;  or  7  to  10  drops  of  Squibb's 
fluid  extract  may  be  used.  The  injections  should  not 
be  made  more  frequently  than  once  in  two  or  three 
days  under  favorable  conditions.     (Al.) 

McEwen's  Method: — Render  the  skin  aseptic  and 
insert  a  needle  into  the  sac  until  it  comes  in  contact 
w^ith  the  other  side.  The  needle  may  be  left  in  for 
twenty-four  to  thirty-six  hours.  Another  plan  of 
McEwen  was  to  introduce  the  needle,  as  just  de- 
scribed, then  to  move  it  about  so  that  the  opposite 
wall  of  the  sac  was  irritated.  The  needle  was  thus 
moved  for  about  ten  minutes,  then  changed  to  an- 
other point  without  w^ithdraw^ing.  In  this  instance 
the  needle  was  left  in  only  a  few  hours.  Success  has 
been  attained  by  this  procedure.     (G.  A.  O.) 

Compression  : — This  method  has  been  successfuUj'- 
employed  in  peripheral  aneurisms ;  digital  compres- 
sion is  the  best  plan  to  be  adopted.  Relays  of  stu- 
dents or  others  continuously  applying  compression, 
for  forty-eight  hours,  have  resulted  in  effecting  co- 
agulation and  cure.     (Ty.) 

Injection  of  Astringents:  —  Solutions  of  persul- 
phate or  chloride  of  iron'or  lead  acetate  are  danger- 
ous and  should  not  be  used.     (G.  A.  O.) 

Injection  of  Gelatin: — This  method  has  yielded 
some  remarkable  results  and  seems  worthy  of  further 
consideration,  but  as  yet  the  subject  is  too  recent  to 
form  a  decided  opinion  as  to  its  value. 


ANEURISM.  45 

The  operative  proceeding  is  as  follows :   A  solution 
of  2  grams  of  gelatin  in  100  grams  of  saline  solution 
is  made ;  this  is  injected  under  the  skin  of  the  thigh 
into  the  subcutaneous  cellular  tissues  in  a  dose  of 
250  c.cm.    The  injection  is  renewed  at  varying  inter- 
vals of  time — from  every  two  days  to  fifteen  days. 
As  a  rule,  10, 15,  or  20  injections  are  quite  enough  to 
obtain  a  complete  cure.     Huchard  has  employed  the 
method  in  many  cases,  one  of  which  was  very  seri- 
ous, the  pulsation  of  the  aneurism  being  very  strong. 
A  complete  cure  was  obtained  by  means  of  20  in- 
jections.    The  sole  inconvenience  attached  to  this 
treatment  is  that  it  was  very  painful.     Certain  pre- 
cautions have  to  be  observed  in  this  method,  for  a 
patient  under  the  care  of  Boisset,  in  whom  injections 
had  been  made  on  a  small  scale,  lest  the  blood  should 
cogulate  all  at  once,  died  very  suddenly  from  embol- 
ism.  The  injections  must  never  be  made  in  the  neigh- 
borhood of  the  aneurismal  sac,  and  still  less  into  the 
aneurismal  sac  itself.     (P.  M.  J.,  11,  12,  98.)    In  re- 
gard to  this  method  of  treatment  Moyer  (Medicine, 
March,  1898)  draws  the  following  conclusions  from 
a  review  of  the  literature :     (1)  Gelatin  solutions  are 
of  some  value  in  the  treatment  of  saccular  aneur- 
isms; (2)  they  are  of  no  value  in  diffused  enlargements 
of  a  vessel;  (3)  the  remedy  is  used  empirically,  the 
experimental  work  affording  little  or  no  basis  for 
the  treatment;    (4)  solutions  not  stronger  than   1 
per  cent  should  be  used ;  (5)  great  care  should  be  ex- 
ercised in    technique — failures  in  asepsis  are  easilj^ 
made,  as  the  fluid  is  a  good  culture-medium.    The 
solution  should  be  kept  in  a  brood  oven  to  determine 
bacterial  growth;   (6)  there  may  be  dangers  in  the 
treatment,  but  observations  heretofore  made  are  in- 


46  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

sufficient  to  indicate  what  they  are;  (7)  absolute 
rest  in  bed  should  be  enjoined,  and  other  remedies 
suitable  for  these  cases  may  be  given  at  the  same 
time ;  (8)  it  is  not  a  cure  for  aneurism,  but  ma^^  rank 
in  the  future  as  a  treatment;  (9)  the  method  is 
worthy  of  more  extended  trial. 

Morphia  :  —  Injected  hj^podermically,  may  be  re- 
quired from  time  to  time  to  allay  pain.     (G.  A.  O.) 

Introduction  of  Foreign  Substances,  such  as  fine 
v^ire,  catgut  or  horse  hair,  have  been  employed, 
passage  into  the  sac  being  effected  through  a  hypo- 
dermic needle .     ( Ty . ) 


ANGINA  PECTORIS. 

Morphia  :  —  Administered  hypodermicalh'  is  the 
most  prominent  remedy ;  the  dose  for  adults  should 
not  be  less  than  l^  gr.  (Ty.)  It  may  be  effectively 
combined  with  Atropine,  viz.:  atropine,  y^^  gr. ; 
morphia,  %  gr.     (An.) 

Ice : — The  application  of  cold  in  the  form  of  ice 
bags  or  Leiter's  coil  to  the  praecordial  region  often 
will  afford  prompt  relief;  it  is  more  grateful  to  some 
patients  than  heat,  and  generally  should  be  first 
tried.     (An.) 

Heat : — Hot  fomentations,  bran  poultices,  hot  wa- 
ter bags,  etc.,  may  be  used  if  cold  is  not  effective. 
(R.) 

Hot  Sinapisms : — Applied  over  the  region  of  the 
heart  is  a  convenient  and  effective  way  to  emploj^ 
counter-irritation  and  affords  relief.     (Ty.) 

Nitro-Glycerine  : — 1  per  cent,  solution  in  1  minim 
doses  hypodermically,   frequently  repeated    if  pain 


ANOSMIA.  47 

continues,  may  be  used  in  cases  characterized  by 
high  arterial  tension.     (An.) 

Amyl  Nitrite: — Inhalations  of  3  to  5  drops  on  a 
handkerchief  affords  prompt  relief  in  cases  where 
artificial  tension  is  high ;  when  the  vessels  are  ather- 
omatous and  heart  fatty  it  must  be  used  with  cau- 
tion.    (B.) 

Electricity : — Goodno  favors  galvanism,  following 
the  advice  of  Eulenburg,  who  recommends  the  appli- 
cation of  the  anode  to  the  sternum,  and  the  cathode 
to  the  lower  portion  of  the  cervical  region  of  the 
spine.     Faradism  is  useful  in  pseudo-angina.    (Gn.) 


ANOSMIA. 

Strychnine  : — ^V~"T4  S^-  i^  ^  neutral  medium  bj'  in- 
sufflation was  employed  by  Morrell  Mackenzie.  It 
should  be  remembered  that  alkaloids  are  more 
readily  absorbed  by  the  mucous  membrane  of  the 
nose  than  by  that  of  the  stomach.     (Al.) 

Electricity:  —  Galvanism  applied  daily,  using  a 
weak  current,  increasing  the  strength  according  to 
toleration.  Faradism  may  also  be  employed,  and  in 
hysterical  cases  applied  to  the  nose  sufficientlj'- 
strong  to  cause  pain,  is  productive  of  good  results. 
(T.,  99.) 

Stimulation  by  Powerful  Odors : — Pow^erful  but 
agreeable  and  non-irritating  odors  by  olfaction  are 
recommended.  They  should  be  frequently  changed, 
using  half  a  dozen  a  day,  applying  first  to  one 
nostril  then  to  the  other.  Better  results  are  obtained 
than  by  strychnine  or  electricity.     (Bos.) 


48  DIGEST   OF   EXTERNAL  THERAPEUTICS. 


ANTHRAX— MALIGNANT  PUSTULE. 

As  soon  as  recognized  thoroughly,  Excise  and 
Cauterize  the  raw,  exposed  surface  with  the  Gal- 
vano-Cautery,  pure  Carbolic  Acid,  Nitric  Acid,  or 
Caustic  Potash;  applications  like  iodine,  etc.,  are 
absolutely  useless.     (Gn.) 

Carbolic  Acid : — Subcutaneous  injections  several 
times  daily  of  a  solution  (about  2  per  cent.),  a  little 
distance  from  the  seat  of  the  lesion  has  proved  effect- 
ive in  preventing  the  braw^ny  oedema.  To  prevent 
extension,  the  neighboring  parts  may  be  bathed  with 
a  10  per  cent,  solution  in  oil  or  glycerine.     (An.) 

After  removal  of  foci  by  the  actual  cautery,  inject 
hydrogen  peroxide  and  apply  compresses  of  carbolic 
acid  solution  1-50.     (Sj.) 

Injections  of  a  solution  of  one  part  of  carbolic  acid 
to  five  of  glycerine  are  also  advised,  administering 
20  to  30  minims  around  the  sloughing  tissues,  but 
not  into  the  same;  the  needle  should  be  introduced 
about  one  inch,  and  withdrawn  slowly  while  press- 
ing out  the  solution;  the  surface  should  then  be 
dressed  with  carbolic  fomentations  1-40,  which 
should  be  continued  until  the  slough  separates.   (Sj.) 

Iodine  Injection: — A  10  per  cent,  solution  or  the 
pl^re  iodine  are  recommended  in  conjunction  with  the 
thermo-cautery.     (T.,  98.) 

Deep  Crucial  Incisions: — Followed  by  the  applica- 
tion to  the  bottom  of  the  incisions  of  Carbolic  Acid 
1—20,  or  Bichloride  of  Mercury  4  to  15  per  cent, 
mixed  with  calomel,  constitutes  another  method ;  as 
the  solution  dissolves,  it  deepens  the  cauterization. 
(Ty.) 


ANUS,    FISSURE   OF.  49 

Antianthrax  Serum  :— Twenty-seven  patients,  it  is 
said  have  been  successfuily  treated  by  Scalvo's 
serum.  In  a  recent  case  of  Dr.  Abba  and  Dr.  Pic- 
cardi,  of  Turin,  22  c.c.  were  injected  in  the  evening 
follov^ed  by  an  injection  of  11  c.c.  the  next  morning. 
The  patient  recovered  and  constituted  the  twenty- 
seventh  case.     (G.  O.,  3,  99.) 


ANUS,  FISSURE  OF. 

Before  making  any  application  order  enema  if  the 
bowels  have  not  already  moved,  and  cleanse  the 
parts  externally  with  some  antiseptic  -wash. 

Nitrate  of  Silver: — One  of  the  most  effective  reme- 
dies, a  w^eak  solution  of  gr.  x-xv— ,^j  will  often  afford 
relief  and  should  generally  be  tried  first.    (Gt.) 

The  crayon  applied  every  two  or  three  days  will 
sometimes  effect  a  cure,  but  must  be  used  with  cau- 
tion. (K.)  Andrews  recommends  that  the  part  be 
first  cocainized,  then  touched  with  the  fused  nitrate 
and  the  following  excellent  ointment  applied  : 
9;.    lodoformi,  3J. 

Ung.  Belladonnse,  §ss. 

Acid.  Carbolici,  gr.  x. 

Cosmolini,  gss. 

M. 

This  should  be  applied  thoroughly  every  day  after 
irrigation  with  antiseptic  lotions.  The  silver  in  solu- 
tion may  be  repeated  every  third  day.     (Ad.) 

Goulard's  Cerate : — Applied  on  a  small  pledget  of 
lint  will  often  effect  a  cure.     (K.) 

Morphine  : — For  diminishing  the  painful  sphincter 
contractions  the  following  ointment  has  proved  very 
effective : 
5 


50     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

9^.    Morphise  sulphatis,  gr.  %. 

Ex.  Belladonnae,  gr.  ss. 

Vaselini,  ^j. 

M.  (Gt.) 

Sig. — Apply  at  once. 

Dusting  powders  are  frequently  both  stimulating 
and  healing,  viz:  Calomel,  Iodoform,  lodotannin. 
Bismuth,  etc.;  one  of  the  most  useful  is  the  follow- 
ing: 

9;.    Hydrargyri  Chloridi  Mitis,  ^ij. 

Zinci  Stearatis  cum  Bal.  Peru.,  jij. 

Sodii  Salicj'latis,  3J. 
M.  (Gt.> 

Conium  : — For  the  relief  of  painful  defecation : 

9;.    Ext.  Conii,  3J. 

Ol.  Ricini,  ^ss. 

Lanolini ,  ^j. 
M.                        '  (T.,98.) 

Ichthyol : — First  anaesthetize  the  part  with  cocaine, 
then  apply  the  remedy  pure ;  repeat  the  application 
for  several  days ;  on  the  fifth  application  the  cocaine 
is  introduced  as  far  as  the  internal  sphincter,  the 
anus  slightly  dilated  with  a  Nelaton's  dilator,  and 
the  fissure  more  thoroughly  touched  with  the  ich- 
thyol. For  recent  cases  ten  applications  will  be  nec- 
essary, for  old,  twenty  may  be  required.     (T.,  98.) 

A  line  of  treatment  followed,  it  is  said,  with  some 
success  by  certain  itinerants,  is  the  following : 

9;.    Ext.  Dest.  Hamamelidis,  3  v. 

Liq.  Ferri  Subsulphat.,  3J. 

Acid.  Carbolici,  gr.  ij, 

Glycerini,  ^ij. 

M. 

Mix  half  a  drachm  of  this  with  half  a  drachm  of 


ANUS,    FISSURE  OF.  51 

starch,  and  add  one  and  a  half  ounces  of  water ;  in- 
ject this  every  morning  into  the  bowel. 

The  following  is  recommended  to  be  applied  with  a 
camel's  hair  brush : 

9;.    Hydrarg.  Biclilorid.,  gr.  j. 

Acid.  Carbolic,  (crystal).  ^ij. 

Morph.  Hydrochlorat. ,  gr.  v. 

Aq.  Destill.,  iiv. 
M. 

After  application  dust  with  iodoform.  An  oint- 
ment of  Mr.  Allingham's  is  the  following : 

ffc.    Hydrarg.  Biclilorid. ,  gr.  iv. 

Pulv.  Opii,  gr.  ij. 

Ext.  Belladonnae,  gr,  ij. 

Ung.  Sambuci,  ^j. 
M.  (Ad.) 

Hydrastis : — The  fluid  extract  applied  pure,  tends 
to  promote  healing  (B.) ;  also  a  glycerole  of  1  drachm 
of  the  tincture  to  glycerine  half  an  ounce;  or  the 
alkaloid  in  combination  with  hamamelis,  viz.: 

9;.     Hydrastis  Mur.,  gr.  j. 

Tr.  Hamamelidis,  gij. 

Aq.  Destill.,  ^j. 
M.  (Rd.) 

Among  other  useful  remedies  are  .ffisculus  Hip., 
the  cerate  to  be  applied  after  defecation;  Zinc  Oxide 
with  vaseline  in  the  proportion  of  a  drachm  to  the 
ounce.  Tr.  Hamamilis,  1  part  to  4  of  glycerine  for 
soreness  about  the  parts.  Tannin,  1  drachm  to  4 
4- ounces  of  glycerine.     (Rd.) 

Opium,  Belladonna,  and  Stramonium  Ointments, 
and  lotions  of  Cocaine  form  useful  palliatives. 

When  local  remedies,  which  in  many  instances  are 
only  palliatives,  have  failed,  incision  or  forcible  dila- 
tion of  sphincter  should  be  employed. 


52  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Incision : — Draw  the  knife  through  the  ulcer  and 
muscular  fibres,  which  can  be  done  with  the  use  of 
cocaine  injected  beneath  the  ulcer.  It  is  not  neces- 
sary to  cut  entirely  through  the  sphincter,  yet  the 
muscular  fibres  at  the  base  of  the  ulcer  should  be  cut 
through  and  the  incision  made  deep  enough  to  pro- 
duce some  relaxation  of  the  muscle.     (K.) 

Dilatation  of  the  Sphincter : — The  patient  should 
be  freely  anaesthetized ;  then  the  thumbs  or  index 
fingers  are  inserted  into  the  bowel  and  separated  in 
different  directions,  care  being  exercised  not  to  lacer- 
ate the  mucous  membrane ;  the  anus  should  be  thus 
stretched  until  it  becomes  patulous.     (Gt.) 

Daily  washing  the  part  with  cold  water  and  a  soft 
sponge  and  avoidance  of  all  local  irritation  consti- 
tute the  best  preventive.  The  insertion  of  a  piece  of 
soft  lint,  changed  daily,  is  also  of  service.     (K.) 


ANUS,  FISTULA  OF. 

Some  cases  w^ill  yield  to  local  applications  if  dili- 
gently and  patiently  pursued,  though  the  majority, 
especially  those  of  long  standing,  can  only  be  cured 
by  an  operation.  In  recent  cases  of  ischio-rectal  ab- 
scess, with  external  opening  and  no  internal  open- 
ing, the  probabilities  of  success  by  the  use  of  local 
remedial  agents  are  very  good.  The  patient  should 
be  kept  in  bed,  the  orifice  of  the  abscess  enlarged, 
and  free  drainage  established,  followed  by  injections 
of  Bichloride  of  Mercury  1—2000,  or  some  other 
antiseptic.  In  older  cases,  when  there  is  a  pyogenic 
membrane,  more  vigorous  measures  are  necessary, 
such  as  turpentine,  iodine,  etc.     (K.) 


ANUS,   FISSURE  OF.  53 

In  children  ascarides  will  often  be  found  to  be  the 
cause,  upon  the  removal  of  which  union  A\all  gener- 
ally take  place. 

Tents  of  sea  tangle  may  be  introduced  into  the  ex- 
ternal orifice  of  the  track  for  enlarging  the  opening, 
permitting  free  drainage  and  the  application  of  anti- 
septic and  other  remedial  agents.     (All.) 

Carbolic  Acid : — Applied  in  the  following  manner, 
has  sometimes  been  attended  with  good  results :  A 
piece  of  cotton  is  placed  upon  the  end  of  a  wire, 
w^hich  has  been  roughened  in  order  to  retain  it ;  this 
is  dipped  in  a  solution  of  carbolic  acid,  9  parts,  with 
w^ater  1  part.  After  thoroughly  cleansing,  the  wire 
is  inserted  to  the  bottom  of  the  fistula,  which  is  then 
swabbed  with  the  solution ;  a  drainage  tube  is  now 
inserted  to  the  bottom  of  the  sinus.  If  the  treat- 
ment is  successful,  the  tube  will  be  found  to  require 
shortening  day  by  day.  The  application  may  be  re- 
peated.    (All.) 

A  method  of  treatment  which  is  said  by  Andrews, 
of  Chicago,  to  be  that  of  the  so-called  "  Brinckerhoff 
Cure  "  is  as  follows : 


9:.     Ext.  Destill.  Hamamelidis, 

3v. 

Liq.  Ferri  Subsulphatis, 
Acid.  Carbolici, 

3J- 

gr.  ij 

Glj'cerini, 
M. 

3ij. 

Inject  10  to  15  drops  deep  into  the  fistula,  and 
press  around  its  periphery,  so  that  the  fluid  will  sink 
in  more  deeply ;  then  inject  equal  parts  of  oil  of  Eu- 
calyptus, and  Glycerine,  and  keep  the  patient  in  bed 
for  two  daj'S.     (Ad.) 

Hydrastis  and  Hamamelis  : — The  following  will 
prove  of  service : 


54  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

9^.    Hydrastis  Mur.,  gr.  j. 

Tr.  Hamamelidis,  3ij- 

Aq.  Destill.,  5j. 

M.  (Rd.) 

For  stimulating  remedies,  Kelsey  mentions:  Sul- 
phate of  Copper,  Balsam  of  Peru,  Nitrate  of  Silver, 
Chromic  Acid,  and  Caustic  Potash. 

Antiseptic  powders  and  solutions  may  generally 
be  employed  for  cleansing  and  dressing,  as  well  as 
for  their  healing  properties. 

Paquelin  Cautery: — This  agent  applied  to  the 
whole  extent  of  the  fistulous  tract  may  be  used  in 
some  cases  of  the  tuberculous  variety. 

Operation  by  the  Elastic  Ligature  is  not  to  be  con- 
sidered except  when  the  knife  is  refused.     (K.) 


ANUS,  PRURITUS  OF. 
See  Pruritus. 

APOPLEXY. 

During  the  attack,  if  possible,  convey  the  patient 
to  a  large  apartment  supplied  with  plenty  of  cold 
air,  and  loosen  the  clothing  around  the  neck. 

Rest: — Should  be  absolute  and  the  head  high;  if 
stertorous  breathing  is  present  the  patient  should  be 
placed  on  the  paralyzed  side ;  the  movement  of  the 
healthy  side  will  then  be  free,  and  the  affected  side  of 
the  cranium  uppermost,  thus  doing  away  with  the 
influence  of  gravity.  If  there  is  difiiculty  in  remov- 
ing the  clothing,  rip  up  the  seams.     (Gn.) 

Ice : — Should  be  applied  to  the  nape  of  the  neck 


APOPLEXY.  55 

and  head  when  there  are  no  symptoms  of  collapse, 
but  cold  applications  are  contra-indicated  when  the 
face  is  pale  and  the  surface  cold.     (Ga.) 

Heat  and  Sinapisms  : — Applied  to  the  extremities 
and  axillae  are  indicated  in  collapse ;  cloths  wrung 
out  in  hot  mustard  water,  and  wrapped  around  the 
limbs,  and  sinapisms  to  the  nape  of  the  neck  should 
be  employed,  with  the  hope  of  bringing  about  reac- 
tion.    (Gn.) 

Dry  Cups,  Turpentine  Stupes,  and  Sinapisms  are 
greatly  to  be  preferred  to  the  old  methods  of  cups 
and  leeches,  which,  however,  may  do  good,  but  only 
from  their  derivative  and  counter-irritant  effect. 
(B.) 

Chapman's  Spinal  Ice  Bag: — This  is  an  import- 
ant and  effective  agent.  The  method  of  application 
and  indications  are  fully  described  in  the  article  on 
Paralysis. 

"  Bleeding  the  Patient  Into  His  Veins  :"— This 
measure  was  suggested  by  Dr.  Dawbarn,  of  New 
York,  and  is  described  as  follows  :  "  Apply  Esmarch 
bandage,  a  tourniquet,  or  Spanish  windlass,  to  one 
or  more  of  the  extremities  as  near  the  trunk  as  pos- 
sible. The  apparatus  should  be  sufficiently  tight  to 
obstruct  the  return  flow  through  the  veins  quite 
thoroughly,  but  not  so  much  as  to  interfere  with  the 
arterial  flow^  Experimental  evidence  shows  clearly 
that  this  procedure  lowers  arterial  tension,  and 
favors  cessation  of  internal  heemorrhage.  The  press- 
ure should  be  kept  up  for  about  an  hour,  then  the 
blood  should  be  permitted  to  enter  the  general  circu- 
lation very  slowly.  The  only  objection  to  this 
method  is  that  of  possible  danger  in  the  hands  of 
those  who  are  unskillful  and  lack  judgment."     (Gn.) 


56  DIGEST   OF   EXTERNAL  THERAPEUTICS. 


APPENDICITIS. 

The  following,  in  conjunction  with  internal  medi- 
cation, is  advocated  by  Dr.  M.  O.  Terry : 

Colon  Enemata  : — Every  three  to  six  hours.  In  the 
first  instance  inject  4  ounces  of  Glycerine,  following 
w^ith  an  injection  of  Soda  Bicarbonate,  1  drachm  to 
1  quart  of  water;  in  subsequent  enemata  6  to  8 
ounces  of  Sweet  Oil  are  injected  after  the  colon 
enema.  The  hips  of  the  patient  during  the  adminis- 
tration should  be  well  raised.  Hot  Fomentations  of 
flaxseed  are  kept  applied  to  the  abdomen  and  hot 
sweet  oil  is  poured  over  the  poultice  and  applied  to 
the  abdominal  walls.     (M.  T.,  11,  97.) 

Ice  : — Applications  afford  relief  and  may  act  as  a 
substitute  for  morphine.     (Ty.) 

Morphine:  —  From  a  surgical  standpoint  is  con- 
demned, pain,  it  is  claimed,  being  relieved  by  evacua- 
tions. (Cr.)  It  is  advised  by  some  medical  writers 
to  be  administered  hypodermically,  but  never  by  the 
mouth.     (Ty.) 

Operation : — Dr.  G.  F.  Shrady  has  summarized  the 
indications  as  follows : 

1.  The  continuously  frequent  or  progressively  ac- 
celerated pulse  rate  is  of  itself  a  prime  indication  for 
operation. 

2.  Pain,  localized  and  progressive,  is  a  valuable  as- 
sociated condition.  When  pain  is  sudden,  severe,  and 
progressive,  and  accompanied  wdth  chill,  it  means 
perforation  or  abscess  rupture  and  immediate  opera- 
tion. 

3.  Increase  of  temperature  is  third  in  importance^ 


ARTHRITIS.  57 

but  when  associated  with  one  or  more  of  the  previ- 
ous symptoms,  and  more  especially  with  increase  of 
pulse  rate,  it  makes  immediate  operation  a  foregone 
conclusion. 

4.  The  gradual  subsidence  of  the  three  cardinal 
symptoms — pulse  rate,  pain,  and  temperature — is  a 
legitimate  reason  for  postponing  immediate  opera- 
tive interference. 

5.  In  cases  of  abscess  it  is  generally  safer,  while 
Avatching  for  urgent  indications,  to  Avait  until  adhe- 
sions have  formed  a  sufficiently  protective  wall. 

6.  In  cases  of  recovery  after  mild  attacks  and  with- 
out operation  we  are  never  sure  of  recurrence  until 
the  latter  takes  place,  v^hen  the  operation  can  be 
done  soon  enough,  and,  all  other  circumstances  being 
equal,  preferabW  in  the  interval  of  a  succeeding  at- 
tack and  when  the  tissues  are  not  in  an  inflamed  con- 
dition. 

The  fact  must  not  be  overlooked  that  there  are  ex- 
ceptions to  all  the  points  named ;  that  patients  with 
a  temperature  and  pulse  almost  normal  and  with 
little  pain  may  become  rapidly  worse  and  die ;  that 
cases  which  are  apparently  mild  in  the  beginning 
may  develop  most  alarming  symptoms  in  the  end. 
Few,  how^ever,  present  these  phenomena  wdthout 
some  preliminary  warning.  These  are  irregular  cases 
and  should  always  arouse  suspicion.  (M.  R.,  1,  9, 
97.) 


ARTHRITIS. 

Lithium  Carb.: — Garrod  has  been  successful  in  re- 
moving gouty  deposits  from  the  hands  and  fingers 


58      DIGEST  OF  EXTERNAL  THERAPEUTICS. 

by  the  use  of  lint  soaked  in  a  solution  of  5  grains  to 
the  ounce  and  kept  constantly  applied.     (Al.) 

Cold  W^ater  Compresses  : — Applied  to  the  involved 
joint  are  often  of  benefit ;  a  10  per  cent,  solution  of 
salic3date  of  soda  maj^  be  used  for  wetting  the  com- 
presses.    (Sm.) 

Dry  Superheated  Air: — The  application  of  dry 
heat  at  a  high  temperature  has  been  attended  with 
good  results,  A  specially  constructed  apparatus  is 
required  for  the  purpose.     (A.  S.) 

Ichthyol : — The  application  of  this  remedy  as  rec- 
ommended for  rheumatism  is  said  to  be  of  great 
benefit  in  arthritis  deformans.  (M.  T.,  10,  99.)  See 
Rheumatism. 

Cataphoresis : — The  foUow^ing  method  is  of  value: 
The  positive  pole  connected  with  a  carbon  electrode 
is  immersed  in  a  vessel  containing  a  2  per  cent,  solu- 
tion of  lithium  chloride,  which  has  been  rendered 
alkaline  with  lithium  carbonate ;  the  negative  pole  is 
placed  in  another  vessel  containing  a  ^veak  solution 
of  chloride  of  sodium.  The  part  to  be  treated  is  im- 
mersed in  the  lithium  carbonate  bath,  and  a  conveni- 
ent member,  as  the  hand  or  foot,  is  placed  in  the  salt 
solution.  The  battery  should  be  one  of  48  Lechanche 
cells  and  a  current  of  10  to  30  milliamperes  should  be 
applied  for  thirty  minutes ;  some  can  only  stand  10 
milliamperes.  Good  results  have  also  been  obtained 
w^ith  salicylic  acid  and  salicylate  of  soda  used  in  a 
vsimilar  manner.     (T.,  98.) 

Galvanism:  —  Applied  directly  to  the  joints  also 
affords  relief  of  the  pain.     ( Gn. ) 

Massage  : — This  is  the  most  efficient  measure  for 
the  reduction  of  swelling,  as  it  promotes  absorption 


ASCARIDES.  no 

of  the  inflammatory  exudates  and  lessens  the  rigidity 
of  the  joints  and  muscles.     (An.) 

The  baths  of  Hot  Springs,  Virginia  and  Arkansas, 
of  Richfield,  N.  Y.,  St.  Catherine  in  Canada,  Aix  les 
Bains,  La  Bourboule,  Ro3'at,  Wiesbaden,  Homburg, 
Gastien,  Carlsbad,  Wiltbad,  Acqui  and  Battaglici,  in 
Europe  are  among  the  most  prominent.  The  selec- 
tion of  one  of  these  springs  must  depend  upon  the 
requirements  of  each  individual  case,  for  what  will 
suit  one  will  not  benefit  or  Avill  positively  harm 
others. 

When  trophi  burst  and  form  indolent  ulcers  which 
penetrate  to  the  joint,  the  most  effectiA-e  way  to  ob- 
tain resolution  is  to  immerse  the  part  in  hot  water 
for  some  hours  daily.     (Alb.) 


APHTHAE. 
See  Stomatitis. 

ASCARIDES. 

ASCARIDES  LUMBRICOIDBS. 

These  parasites  have  their  seat  in  the  small  intes- 
tines, but  being  liable  to  migrate  they  may  some- 
times be  reached  by  the  injections  used  for  seat 
worms. 

ASCARIDES  VERMICULARES. 

Before  using  any  form  of  rectal  injection  for  the 
removal  of  these  parasites  the  bowel  should  be  first 
cleansed  bv  an  enema  of  warm  \vater. 


60  DIGEST  OF   EXTERNAL  THEKAPEI'TICS. 

The  following  injections  are  recommended  : 
Infus.  Quassia,  one  of  the  most  efficacious;  Lime 
Water,  simple  and  satisfactory ;  Salt,  3  tablespoon- 
fuls  to  half  a  pint  of  water;  Salicylic  Acid  and  Bi- 
carbonate of  Soda,  half  a  drachm  of  each  with  1  pint 
of  w^ater. 


ASPERGILLI. 

Boric  Acid: — As  a  lotion  is  especially  effective  after 
bichloride  of  mercury  lotions.     (Al.) 

Chlorinated  Lime: — Grains  ij-.lj,  useful  for  destruc- 
tion of  colonies  of  these  growths  in  the  external 
meatus.     (Al.) 

Acid  Salicylic: — 2  per  cent,  in  dilute  alcohol.    (Bn.) 

Chinoline  Salicylate  and  Boric  Acid: — 1  part  of 
the  former  to  8  to  16  of  the  latter,  give  the  best  re- 
sults, and  should  be  tried  first.  For  the  inflamma- 
tion after  the  removal  of  the  growth  the  above 
powder  of  chinoline,  or  the  following  recommended 
by  Dr.  Hint  on,  will  prove  effective : 


9;.    Liq.  Plumbi  Subacetatis, 

M.xx. 

Acid.  Acetic.  Diluti, 

M.vj. 

Liq.  Opii  Sedativ-i, 

M.xx. 

Aq.  Destill., 

q.s.  ad  .5j. 

M. 

Sig.     lo  drops  in  the  ear. 

Alcohol: — Instilled  several  times  a  day  forms  an 
excellent  parasiticide  ;  after  its  use  the  debris  may  be 
easily  syringed  away.     (Str.) 


ASPHYXIA,  61 


ASPHYXIA. 

The  conditions  produced  by  the  inhalation  of  ordi- 
nary illuminating  or  other  poisonous  gases,  as  well 
as  asphyxiation  by  smoke  or  hanging,  are  all  essen- 
tially the  same  and  require  the  same  treatment. 
Give  the  patient  plenty  of  air ;  dash  cold  water  on 
the  face;  administer  inhalations  of  ammonia  and 
slap  the  epigastrium.  If  these  simple  measures  have 
no  effect,  immediately  employ  artificial  respiration 
as  subsequently  described. 

Asphyxia  from  Drowning  : — The  treatment  should 
be  carried  out  at  once  at  the  place  of  rescue,  except 
perhaps  in  extreme  weather.  Immediately  turn  the 
patient  over  with  the  face  downw^ard,  resting  on  one 
arm  with  the  wrist  under  the  head  in  order  to  cause 
the  water  to  run  out  of  the  mouth  and  throat.  The 
abdomen  may  rest  on  a  roll  of  clothing.  Run  the 
fingers  into  the  mouth  to  clear  aw^ay  any  obstruc- 
tion, then  with  the  patient  in  this  position  press 
each  side  of  the  back  over  the  lungs.  This  is  done  to 
expel  any  water  that  may  be  in  the  upper  air  pass- 
ages. Next  turn  the  patient  on  his  back,  strip  to 
the  v^aist  and  rub  dry.  These  procedures  should  be 
executed  with  the  utmost  rapidity,  and  during  the 
time  they  are  being  carried  out,  an  assistant  may 
apply  inhalations  of  ammonia.  If  these  efforts  are 
ineffectual,  employ  artificial  respiration  by  Silvest- 
er's or  Marshall  Hall's  method. 

Silvester's  Method: — This  method  is  generally 
employed.  Place  the  patient  on  his  back  with  a 
cushion  or  a  folded  coat  under  his  shoulders.    Next 


62  DIGEST    OF   EXTERNAL   THERAPEUTICS. 

draw  the  tip  of  his  tongue  forward  in  order  to  pre- 
vent obstruction  of  the  air.  The  tongue  may  be 
grasped  with  a  handkerchief  or  covered  with  sand 
or  earth  to  prevent  sHpping ;  if  alone,  tie  the  tongue 
against  the  lower  teeth  by  means  of  a  strip  of  cloth 
or  muslin,  carrying  the  ends  around  the  neck  and 
tying  on  one  side.  Now  kneel  behind  the  patient  and 
grasp  both  arms  half  way  between  the  elbow  and 
wrist,  then  draw  them  gently  but  steadily  upward 
until  they  meet  on  the  ground  above  the  head.  Re- 
tain them  in  this  position  two  seconds,  then  bring 
them  down  gently,  thus  reversing  the  movement, 
and  press  them  firmly  against  the  chest  -walls  for 
about  three  seconds,  causing  the  elbows  to  meet 
over  the  epigastrium.  This  manoeuvre  should  be 
executed  at  the  rate  of  fifteen  to  sixteen  times  a 
minute. 

Marshall  Hall's  Method: — The  patient  is  placed 
flat  on  his  face.  Then  gentle  intermittent  pressure  is 
made  with  both  hands  on  the  back,  the  body  being 
turned  on  the  side  or  a  little  beyond ;  then  on  the 
face  and  the  same  pressure  continued.  The  whole 
body  should  be  worked  simultaneously,  and  the 
movements  made  at  the  rate  of  fifteen  to  sixteen 
per  minute. 

Michigan  Method : — The  patient  is  laid  on  the  face 
and  the  head  upon  the  arm.  Then  stand  astride  the 
body,  and  grasp  it  about  the  shoulders  and  armpits 
and  raise  the  chest  high  as  you  can  vc^ithout  lifting 
the  head  quite  off  the  arm.  Hold  it  in  this  position 
for  about  three  seconds,  then  replace  the  body  on  the 
ground,  and  press  the  lower  ribs  do-wnward  and  in- 
w^ard  with  a  slowly  increasing  force  for  three  sec- 


ASPHYXIA.  63 

onds,  then  suddenly  let  go  and  commence  the  move- 
ment over  again. 

The  temperature  of  the  body  during  the  process  of 
resuscitation  should  be  maintained  by  hot  water 
bottles,  hot  bricks,  flannel,  etc.  Friction  upward 
should  also  be  employed. 

Asphyxia  Following-  Ansesthesia  :  —  See  Anaesthe- 
sia. 

Asphyxia  in  the  New  Born: — When  labor  has  been 
long,  tedious,  and  difficult,  preparations  should  be 
made  beforehand  for  the  reception  of  a  probably  as- 
phyxiated child.  A  table  with  waterproof  sheet  and 
receptacles  for  hot  and  cold  water  should  be  at  hand, 
also  a  soft  rubber  catheter  or  some  such  instrument 
for  clearing  the  throat  of  mucus. 

(A)  Treatment  of  the  first  or  comparatively  milder 
forms:  Remove  all  obstructions  from  the  air  pass- 
ages, clearing  mucus  from  the  throat  and  mouth, 
slap  the  buttocks,  irritate  the  skin  wath  rubbing,  and 
pass  before  nostrils  some  diffusible  stimulant,  such  as 
camphor  spirits,  or  preparations  of  ammonia.  To 
remove  mucus,  pass  the  finger  into  the  throat  or 
press  the  trachea  with  the  fingers  as  lo^w  dow^n  as 
the  bifurcation  and  gently  squeeze  it  against  the 
larynx;  this  forces  the  mucus  into  the  pharynx, 
whence  bj^  blowing  into  the  mouth  it  can  be  forced 
out  through  the  nose.  If  the  infant  does  not  now 
begin  to  breathe,  a  warm  bath  should  be  adminis- 
tered, or  alternate  cold  and  warm  baths. 

(B)  Treatment  of  the  second  or  severe  form:  The 
air  passages  should  immediately  be  cleared  of  mucus. 
Then  artificial  respiration  should  be  practiced  ac- 
cording to  the  method  of  Silvester  or  according  to 
the  proceeding  of  Schultz,  which  is  as  follow^s :  Grasp 


64  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

the  child  by  the  shoulders,  placing  the  index  fingers 
in  the  axillae  and  the  thumbs  curved  forward  over 
the  shoulders  so  as  to  meet  the  ends  of  the  fingers ; 
thus  the  entire  weight  of  the  child's  body  rests  upon 
or  within  a  circle  made  by  the  thumb  and  first  finger 
of  both  hands.  While  the  body  is  thus  hanging  per- 
pendicularly, the  ribs  are  lifted  out  and  chest  ex- 
panded, and  an  artificial  respiration  produced.  The 
body  is  nowsw^ung  forw^ard  w^ithsome  force  at  arm's 
length  until  the  operator's  arms  are  about  on  a  hori- 
zontal line.  A  somewhat  abrupt  termination  of  the 
movement  causes  the  child's  thorax  to  become  sta- 
tionary, while  the  lower  limbs  fall  forward  upon  the 
abdomen;  the  abdominal  viscera  now  press  against 
the  diaphragm  and  produce  expiration,  the  body  is 
returned  to  the  first  position  and  the  manoeuvre  re- 
peated. Seven  to  eight  seconds  are  required  for  each 
movement,  v^'hich  should  be  repeated  eight  to  ten 
times  per  minute.  After  two  or  three  minutes  ad- 
minister a  warm  bath.     (Am.) 

Blowing  inta  the  mouth  is  another  procedure  em- 
ployed to  inflate  the  lungs.  When  this  is  done  cover 
the  infant's  mouth  v^ith  a  towel  and  blow  in  it  and 
press  the  lungs  gently.     (Am.) 

Asphyxia  from  Foreign  Bodies  : — When  a  foreign 
body  in  the  air  passages  is  the  cause,  invert  the  pa- 
tient and  forciblj'-  slap  him  on  the  back.  This  pro- 
cedure is  indicated  more  especially  when  the  object  is 
smooth  and  round.  If  this  fails  laryngotomy  or 
tracheotomy  should  be  performed  immediately.    (P.) 


ASTHMA.  65 


ASTHMA. 

Treatment  of  paroxysms  will  vary  widely  in  differ- 
ent individuals,  and  not  infrequenth^  the  patient 
from  experience  will  know  the  remedies  most  effect- 
ive in  his  case. 

Cocaine : — Regarded  by  some  observers  of  the  first 
importance,  should  be  applied  to  the  nostrils  wath  ' 
an  atomizer  or  ordinarj'  dropper,  and  repeated  every 
four  minutes  until  relief  is  obtained.  It  is  claimed 
that  on  account  of  the  intimate  sympathy'  between 
the  nasal  and  bronchial  mucous  membranes,  cocaine 
thus  administered  will  afford  relief.     (Bos.) 

Stramcnium: — Used  bj' burning  the  leaves  and  in- 
haling the  smoke,  or  smoking  cigarettes  made  of  the 
leaves,  or  better  3^et  by  placing  some  of  the  leaves  in 
a  pipe  and  smoking.  The  drug  should  be  watched. 
The  smoke  of  about  half  an  ounce  of  the  leaves  may 
be  used  at  a  sitting.  A  sensation  of  heat  in  the 
lungs,  fulness  of  the  head  and  nausea  are  indications 
that  a  maximum  impression  has  been  attained.  (Al.) 

The  following  is  for  a  fuming  inhalation : 

Powdered  Stramonium  Iveaves,  §j. 

Powdered  Fennel  Fruit,  ^ss. 

Iodide  of  Potash,  gj. 

Powdered  Anise  Fruit,  gss. 

Black  Tea  in  Powder,  5j- 

Nitrate  of  Potash,  ^j. 

(T.  97.) 

Nitrate  of  Potash  : — A  very  common  and  effective 

remedy  by  inhalation.    Saturate  a  piece  of  blotting 

paper  about  five  inches  square  in  a  strong  solution 

of  the  saltpetre,  allow  it  to  dry  thoroughlv,  place  it 

6 


66  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

in  a  saucer  by  the  bedside  and  ignite.  Many  patients 
will  fall  asleep  amid  the  fumes.     (Al.) 

Pulv.  Lobeliae  Comp.: — This  is  prepared  as  fol- 
lows :  Nitrate  of  potash,  boiled  distilled  water,  240 
parts  each;  dissolve  and  add  to  lobelia  in  powder ,^ 
stramonium  leaves  in  powder  and  black  tea  in  pow- 
der 240  parts  each.  Mix  well,  dry,  and  add  oil  of 
anise  1  part.  The  fumes  of  half  a  teaspoonful  or 
more  burnt  on  a  plate  may  be  inhaled  six  or  eight 
times  a  day,  and  the  bed  room  fumigated  with  the 
same.  This  is  said  to  be  an  imitation  of  the  well 
known  nostrums,  Himrod's,  Bliss'  and  the  Green 
Mountain  Cures.     (M.  W.) 

Morphia : — Alone,  or  with  Atropia  in  doses  of  ^ 
gr.  and  jj^gr.  respectively,  subcutaneously,  often  re- 
lieves, acting  v^hen  all  other  measures  have  failed. 
The  danger  of  forming  the  morphine  habit  should  be 
considered.     (An.) 

Amyl  Nitrite: — A  few  inhalations  of  from  4  to  6 
drops  will  act  speedily  in  a  certain  proportion  of 
cases.     (Rd.) 

Ethyl  Iodide  : — Inhalations  give  good  results;  use 
8  to  10  drops  on  a  sponge.     (T.,  96.) 

Chloroform  : — Direct  inhalations,  or  the  fumes 
of  chloroform  poured  on  hot  water,  will  afford  quick 
relief  The  danger  of  the  habit  should  not  be  forgot- 
ten.    (B.) 

Arsenic: — Formula  of  Trousseau  for  arsenical  cig- 
arettes : 

9(.    Potass.  Arsenitis,  gr.  xv. 

Aq.  Destill.,  Jj. 

M. 

Unsized  paper  is  thoroughly  wet  with  this  solu- 
tion, dried,  and  cut  into  twenty  equal  parts,  each  of 


ASTHMA.  67 

which  is  to  be  rolled  into  a  cigarette,  and  two  or 
three  smoked  daily. 

The  arsenite  of  soda  may  be  used  under  similar 
conditions  in  the  same  w^ay,  the  strength  of  the  solu- 
tion being  1  drachm  to  1  ounce  of  distilled  water; 
each  cigarette  should  contain  from  ^4  tol  grain.  (B.) 

Pyridine :  — Place  a  saucer  containing  about  a 
drachm  of  the  remedy  in  a  small  room  or  closet 
which  can  be  tightly  closed.  The  patient  then  enters 
and  remains  for  twenty  to  thirty  minutes ;  this  can 
be  repeated  from  two  to  five  times  a  da3^  In  simple 
cases  it  is  claimed  a  cure  may  be  effected  in  from  ten 
to  thirty  daj^s.  It  is  said  to  be  useful  in  asthma 
from  any  cause.     (B.) 

Dilute  Hydrocyanic  Acid  : — 3  drops  to  half  a  pint 
of  hot  water ;  inhalations  of  the  vapor  will  often  ar- 
rest paroxysms.  This  was  recommended  by  Macken- 
zie and  others. 

Grindelia  Robusta  : — A  remedy  of  value.  The  plant 
should  be  steeped  in  a  saturated  solution  of  nitre, 
dried,  ignited  and  the  fames  inhaled  or  made  into 
cigarettes  and  smoked  in  connection  Mrith  stramo- 
nium or  tobacco.     (B.) 

Methyl  Chloride  : — Sprays  applied  rapidly  over  the 
back  are  said  to  cause  an  attack  to  cease  in  a  few 
minutes.  If  they  are  not  successful  light  spraying  on 
the  upper  part  of  the  chest  may  be  tried.     (Sj.) 

Strychnine  : — Subcutaneous  injection  of  a  combina- 
tion of  the  sulphate  of  strychnine  ^  gr,  and  the  Sul- 
phate of  Atrophine  2^75^  gr.  repeated  daily,  have  been 
use.     (Sj.) 

Belladonna  : — In  pastels  with  Stramonium,  Lobe- 
lia, or  Hyoscyamus.     (B.) 


68  DIGEST   OF  EXTERNAL   THERAPEUTICS. 

"Cigarettes  d'Espic"  are  said  to  be  made  of  the 
foUow^ing  ingredients. 

Belladonna  leaves,  5^  parts. 

Hyoscyamus  leaves,  2^  parts. 

Stramonium  leaves,  2^  parts. 

Phellandrium  Aquaticum,  t      part. 

Extract  of  Opium,  }4  part. 

Cherry-laurel  water,  q.  s. 

The  dried  leaves,  stripped  of  their  stems,  are  cut 
small,  w^ell  mixed,  and  then  moistened  Avith  the 
opium  dissolved  in  the  cherrA^-laurel  water.  The 
paper  used  for  making  the  cigarettes  is  also  soaked 
in  an  infusion  of  these  leaves  in  cherry-laurel  water. 
Usualh'  in  making  these  cigarettes,  a  little  nitrate  of 
potash  is  added  to  the  infusion  to  make  them  burn 
freely.     (Y.) 

"  Carton  Fumigatoire"  of  the  French  codex — a  very 
useful  preparation — is  thus  made :  Take  7  ounces  of 
gray  unsized  paper  and  2  ounces  of  powdered  nitre  ; 
take  of  belladonna  leaves,  stramonium  leaves,  digi- 
talis leaves,  and  lobelia  leaves,  each  75  grains ;  take 
of  powdered  myrrh  and  powdered  oliban,  each  150 
grains.  Tear  the  paper  in  pieces  and  soak  it  in 
w^ater,  then  add  the  powders  previoush^  mixed,  and 
pound  and  beat  them  all  together.  Then  spread  out 
the  soft  paste  in  tin  moulds,  and  dr\^  it  in  a  stove. 
Finally  cut  this  quantity  into  thirtA'-six  pieces,  each 
6  centimeters  long  and  4  centimeters  wide.  One  of 
these  is  burnt  in  the  patient's  room.     (Y.) 

Galvanism  of  the  pneumogastric  and  cervical  sym- 
pathetic has  relieved  some  cases  and  entirely'  failed  in 
others.  (B.)  This,  however,  may  be  said  for  all  rem- 
edies recommended  for  asthma. 

In  adopting  any  of  these  expedients  ventilation 


BALANO-POSTHITIS.  69 

must  not  be  neglected ;  the  window's  should  be  regu- 
larly thrown  \vide  open  to  renew  the  air  of  the 
apartment.  It  is  well  to  keep  the  atmosphere  of  the 
room  moist.     (Ga.) 

The  shower-bath  is  a  valuable  and  potent  agent  to 
fortify  the  body  against  asthma ;  the  sudden  appli- 
cation of  water  strengthens  the  whole  system,  and 
renders  the  body  less  sensitive  to  atmospheric 
changes.  Out-of-door  exercise,  as  walking  or  riding, 
is  also  useful,  but  it  should  not  be  taken  until  one  or 
two  hours  after  a  meal,  or  to  such  an  extent  as  to 
occasion  fatigue.     (Rd.) 


BALANO-POSTHITIS. 

In  mild  cases  cleanliness  with  the  application  of 
some  bland  powder  is  usually  all  that  will  be  re- 
quired.    (T.) 

Tepid  Water  Injections  beneath  prepuce  frequently 
applied  (W.),  and  strips  of  lint  laid  between  the  fore- 
skin and  the  glans  removed  as  they  become  moist, 
are  useful. 

The  parts  should  be  bathed  every  two  to  six  hours 
w^ith  one  of  the  following  solutions : 

Carbolic  Acid,  1-100. 

Mercuric  Bichloride,  1-5000. 

Boric  Acid,  saturated  solution. 

Succus  Calendulae,  10  drops  to  water  1  oz. 

Alumnol,  1  to  5  per  cent,  strongly  recommended. 

Zinc  Sulpho-Carbolate,  1  to  5  per  cent. 

After  cleansing  with  an  antiseptic  solution  dusting 
powders  will  be  found  effective,  such  as  Alum,  Tan- 


70     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

nin,  Bismuth  Subnitrate.  While  using,  the  parts 
should  be  kept  separated  with  a  piece  of  lint.     (CI.) 

Lead  and  Opium  ^A^ash: — Continuously  applied  for 
oedema  of  the  prepuce,  is  very  beneficial.     (H.) 

Fid.  Ext.  Hydrastis  : — 1  part  with  dilute  alcohol  4 
parts  as  a  lotion  (Sm.),  or  the  aqueous  extract 
(Emesty)  10  drops  to  1  ounce  of  water.     (CI.) 

Hydrogen  Peroxide : — When  pus  is  present  this 
may  be  used  as  a  douche.     (Cltn.) 

Nitrate  of  Silver : — A  solution  of  10  grains  to  the 
ounce  will  be  found  effective  for  erosions.     (Cltn.) 


BEDSORES. 

The  utmost  care  should  be  exercised  to  guard 
against  the  formation  of  bedsores.  Moisture  being 
a  potent  factor  in  their  causation,  the  patient  should 
be  kept  thoroughly  dry  and  scrupulously  clean. 
Pressure  upon  bom-  prominences  must  be  relieved  as 
much  as  possible  with  air  cushions,  and  in  very 
protracted  illnesses  air  or  water  beds  should  be  used 
when  practicable.  The  exposed  parts  should  be 
bathed  with  castile  soap  and  warm  water,  then 
carefiiUy  dried  with  a  soft  towel. 

The  following  are  recommended  for  application 
with  the  vicAV  of  hardening  the  skin  and  preventing 
the  formation  of  sores : 

Olive  Oil  3  parts,  with  1  part  of  Laudanum,  and 
2  of  Brandy,  w^as  recommended  bj-  Florence  Nightin- 
gale. Brandy,  Proof  Spirit  or  Alcohol  diluted.  (Bt.) 
Collodion,  as  a  protective.     (N.) 

Alum  : — Used  in  various  ways,  the  following  are 
advised : 


BEDSORES.  71 

9;.    Aluminis,  ^  ss. 

Albumin.  Ovi,  No.  iv. 

Tr.  Camphori,  Jij. 
M.  (B.) 

Or: 

^.    Aluminis, 

Sod.  Chloridi,  aa   ^ss. 

Aq.  Destill., 

Alcoholis,  aa  Oj. 

M.  (Sn. ) 

Ammon.  Nitrate : — 5  grains  with  half  an  ounce 
each  of  alcohol  and  water,  diluted  with  equal  parts 
of  water,  was  used  by  Agnew  for  rubbing  on  the 
back.     (Al.) 

Nitrate  of  Silver: — Gr.  x-gj  painted  on  when  the 
skin  is  red  but  not  broken,  is  one  of  the  best  preven- 
tives.    (F.) 

Other  useful  preventives  are  Soap  Plaster  retained 
in  place  by  adhesive  plaster.  Decoction  of  Oak  Bark, 
Glycerine,  Glycerine  Cream,  Opium  Liniment, 
Spirits  of  Camphor,  Hamamelis,  Lime  Water  and 
Solutions  of  Gutta  Percha. 

When  Sores  Have  Formed  antiseptic  washes,  such 
as  the  following  are  called  for : 

Hydrarg.  Bichlorid.,  1-3000-5000. 

Boric  Acid.,  saturated  solution. 

Hydrogen  Peroxide,  1-8  or  stronger. 

Creolin,  5-1000. 

Pyoktanin,  1-1000. 

After  the  application  of  the  selected  antiseptic 
solution,  one  of  the  following  dusting  powders  may 
be  used:  Acetanilid,  Airol,  Dermatol,  Nosophen, 
Iodoform,  Xeroform,  or  Naphthalin,  the  latter  in 
the  strength  of  5  to  10  per  cent.,  the  others  pure. 


72  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

The  same  remedies  may  also  be  used  in  the  form  of 
ointments. 

Calendulated  Boric  Acid  : — Dusted  over  the  sur- 
face, is  highh^  endorsed,  being  employed  with  excel- 
lent results  at  the  Middletown  State  Hospital  for  the 
Insane. 

Calendula: — 1  part  of  the  succuswith  4  to  5  of  a  1 
per  cent,  solution  of  carbolic  acid  forms  a  satisfac- 
tory lotion  for  the  relief  of  soreness.     (M.  H.) 

Compound  Zinc  Stearate  with  a  little  Tannin  may 
be  used  with  good  effect.     (Sm.)    ' 


BITES  OF  INSECTS. 

Liq.  Ammon.,  Ledum  or  Rhus  Tox.  of  either  10 
drops  of  the  mother  tincture  to  the  ounce  of  water. 
Lime  \A^ater,  freshh^  prepared,  a  slice  of  an  Onion, 
Moist  Clay.     (Rd.)' 

Salicylic  Acid: — The  following  will  prove  effective : 

Jpfc.    Acid.  Salicylici,  gr.  ivss. 

Aq.  Ammoniee,  gtt.  xl. 

Collodii,  gr.  Ixxvj. 
M. 

Or: 

5fc.    Acid.  Salicylici,  gtt.  xv. 

Tr.  Benzoini,  gr.  ivss. 

Collodii,  3ijss. 
M.  (T.,97-) 

Camphorated  Chloral  : — Will  quickly  arrest  pain^ 
and  is  effective  for  the  bites  of  scorpions.     (M.  W.) 

Ichthyol : — A  10  per  cent,  plaster  or  an  ointment 
equal  parts  with  lanolin,  or  the  pure  drug  in  severe 


BITES   OF   SERPENTS.  73 

cases,  has  been  productive  of  good  results.    (T.,  98.) 
Potass.   Permang.- — A  2  per  cent,   solution  sub- 
cutaneously,  is  the  best  treatment  for  stings  of  bees 
and  other  poisonous  insects.     (M.  T.,  9,  98.) 
Cocaine  : — Solutions  will  relieve  the  pain.    (M.  W.) 
Nitric  Acid  : — May  be  used  when  a  cauterant  effect 
is  deemed  desirable  as  in  the  case  of  stings  by  espe- 
cially poisonous  insects.     (N.) 
The  following  is  recommended  as  a  preventive : 

Acetic  Ether,  5  parts. 

Eucalyptol,  lo  parts. 

Cologne  Water,  lo  parts. 

Tr.  Pyrethruni,  50  parts. 

(T.,  98.) 


BITES  OF  SERPENTS. 

Ligation  should  be  applied  immediately  to  the  limb 
above  the  wound,  which  should  be  sucked  or  incised 
and  allowed  to  bleed  freely.  An  attempt  should  be 
made  to  express  the  poison  by  bandaging  the  limb 
downw^ards.  When  the  ligature  is  removed  it  should 
be  slackened  slowly.  The  Chinese  apply  as  many  as 
six  tight  bands  above  the  v^'ound  and  generally  es- 
cape.    (T.,  98.) 

Cauterants,  such  as  the  Actual  Cautery,  Nitric 
Acid,  Carbolic  Acid,  or  Bromine  are  generally  em- 
ployed after  sucking  the  wound.     (Ga.)  (B.) 

Potass.  Permang.: — First  apply  a  ligature,  then 
inject  subcutaneously  a  1  per  cent,  solution  near  the 
periphery  of  the  point  of  penetration  of  the  serpent's 
fang.  This  is  regarded  in  Brazil  as  a  very  effective 
antidote.     (Ga.) 


74  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Tr.  Iodine : — Painted  on  the  wound  until  active 
suppuration  takes  place,  is  said  to  be  a  trustwortliA' 
application  for  rattle  snake  bite.     (N.) 

Euphobia  Prostata: — Used  by  the  Indians  and  set- 
tlers in  Arizona  as  an  infallible  remedy  against  bites 
of  poisonous  insects  and  snakes,  especialh^  the  rattle 
snake.     (N.) 

Aralia  Spinosa  : — A  decoction  is  used  by  Southern 
negroes  against  rattle  snake  bites.     (N.) 

Calmette's  Antivenene  Serum: — Reports  of  the 
successful  application  of  this  remedy  have  been  re- 
ceived from  various  sources.  Apparently  there  are 
two  factors  in  snake  venom  to  be  dealt  with,  one 
w^hich  acts  locally  and  the  other  which  causes  gen- 
eral or  constitutional  symptoms.  These  can  be  sep- 
arated chemically  and  ph3^siologically,  and  require 
different  antidotes.  The  poison  in  the  wound  may 
be  treated  by  a  solution  of  Hypochlorite  of  Calcium, 
1—60,  while  for  the  toxine  w^hich  causes  the  consti- 
tutional symptoms  the  antivenene  serum  should  be 
used.  A  case  is  reported  which  was  apparently  at 
the  point  of  death,  where  20  c.  c.  of  Calmette's  serum 
injected  under  the  skin  of  the  abdomen  brought 
about  recovery.  This  w^as  administered  three  hours 
after  being  bitten ;  a  second  dose  of  10  c.  c  was  given 
on  the  second  day,  this  being  the  full  amount.  (T., 
98.) 

Strychnine: — Subcutaneously,  has  been  successfully 
used  in  Australia  and  the  East  Indies.  It  is  em- 
ployed in  large  doses,  carefully  watching  the  effects. 
According  to  the  severity  of  the  condition,  amounts 
varying  from  f  to  3  or  4  grains  v^^ere  given  in  divided 
doses  in  different  cases.     The  symptoms  were  pro- 


BLADDER.  75 

gressively  relieved    and    no  toxic    effects    from    the 
strychnine  were  produced.     (Sm.) 

Digitalis  and  alcoholic  stimulants,  especially  Whis- 
key, should  be  administered  hypodermically.     (B.) 


BLADDER,    IRRITABILITY    AND 
NEURALGIA    OF. 

Full  sized  Steel  Sounds  passed  every  fourth  day 
have  been  effective  in  many  cases.     (CI.) 

Nitrate  of  Silver: — Gr.  j-ij-^j,  1  to  3  drops  applied 
with  the  Taylor  syringe  to  the  prostatic  portion  of 
the  urethra,  is  indicated  in  some  cases.     (CI.) 

Aqua-puncture  has  been  successful.     (B.) 


BLEPHARITIS. 

Rest  and  strict  cleanliness  should  be  enforced  and 
any  errors  of  refraction  corrected.  After  the  re- 
moval of  the  scales,  which  should  be  done  gently, 
the  following  may  be  used : 

Hydrarg.  Oxid.  Flav.: — Gr.  v,  vaseline  Ij  is  valu- 
able for  destroying  any  parasite  which  may  be  pres- 
ent and  for  keeping  the  parts  clean  and  secretions 
soft.  (Mac.)  On  account  of  the  fineness  of  its  parti- 
cles it  is  more  suitable  than  the  red  oxide,  which 
may  also  be  used.     (N.) 

Formalin  : — May  be  employed  in  all  cases  in  solu- 
tion of  the  strength  of  1  to  2  per  cent.,  beginning 
with  the  weaker.  It  must  be  prepared  fresh,  or  at 
the  time  of  using,  to  insure  uniformity  of  strength. 


76     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

A  small  cotton  mop  is  used  for  daily  applications. 
The  proportion  of  cases  benefited  and  the  measures 
of  relief  afforded  constitutes  this  a  superior  remedy. 
(P.  M.  J.,  9,24,  98.) 

Chloral  Hydrate  :— 1-10  in  solution  applied  with 
gentle  friction  is  valuable  Avhen  the  scales  are  diffi- 
cult to  remove.  (T.,  97.)  A  weaker  solution  of  5 
grains  to  the  ounce  is  also  recommended.    (T.,  98.) 

Ung.  Hydrarg  Ammoniat.:— Gr.  ss-^j.  (N.)  Tan- 
nin : — Gr.  V— ?j.  (B.)  Bismuth  Subnitrate: — Equal 
parts  with  glycerine,  in  ciliary  and  granular  forms. 
(Wa.)  Sulphur  and  Resorcin  : — 2  per  cent,  each,  in 
an  ointment  for  squamous  types.  Sulphur  Oint- 
ment : — When  there  is  distinct  desquamation.  Pyro- 
gallic  Acid  : — 5  to  10  per  cent,  ointments  have  given 
good  results.     (T.,  97.) 

Nitrate  of  Silver :— Gr.  x-§j,  applied  to  the  roots 
of  the  hair  acts  well  in  some  cases,  followed  after- 
wards with  vaseline  to  neutralize  the  effects  of  the 
silver  solution.  (Ro.)  The  crayon  may  be  used  on 
exposed  ulcers  follov^ed  by  mercurial  salves.  (T.,  97.) 

Acetate  of  Lead  : — The  follow^ing  is  for  application 
to  the  edges  of  the  lid : 

Neutral  Lead  Acetate,  gr.  ij. 

Cocaine  Hydrochlorate,  gr.  iij. 

White  Vaseline,  gr.  xlv. 

Aristol:— Gr.  x-gj  an  effective  ointment.    (T.,  98.) 


BLISTERS. 

For  healing  the  milder  forms  of  bums  and  erythe- 
ma: 

Cerat.  Cetacei. 


BOILS.  77 

Cerat.  Plumbi  Subacetatis. 

Cerat.  Resinae. 

Fid.  Ext.  Grindeliae  Robust.,  3ss,,  aquae,  ^iv-vj. 

Infus.  Sambuci. 

Ung.  Cetacei. 

Ung.  Zinc.  Oxidi.     (N.) 


BOILS. 

Compare  Abscess. 

Hydrarg.  Bichlorid.: — Solutions  of  1-1000  should 
be  used  for  washing  the  boil  and  surrounding  parts. 
(B.  H.) 

Phenol  and  Mercurial  Plaster.: — Render  the  lesion 
and  surrounding  surface  aseptic  with  a  bichloride 
solution  1—1000,  then  cover  the  part  with  the  plas- 
ter, changing  daily  or  oftener.  If  used  before  fluctu- 
ation absorption  may  be  expected.  The  results  of 
this  treatment  are  excellent.  (T.,  97.)  Van  Hoorn 
recommends  that  the  plaster  be  changed  daily,  and 
the  patient  be  ordered  to  change  the  underclothing 
frequently.  Unna's  plaster  of  carbolic  acid  and  mer- 
cury is  warmly  endorsed  by  Hardaway ;  the  plaster, 
extending  well  beyond  the  lesion,  should  be  used  in 
place  of  a  poultice  which  is  condemned  by  this 
author.  A  small  opening  is  cut  in  the  centre  over 
the  conical  point  of  the  boil;  thus  applied,  matura- 
tion will  be  hastened. 

Iodoform : — When  pain  is  severe,  viz.: 

9(.    lodoformi,  3J. 

Ung.  Vaselini  Plumbici,  ^j. 

M.  (Hd.) 


78  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Iodine : — The  strong  tincture,  frequently  painted  on 
the  part,  has  been  used  with  a  view  of  aborting;  it 
is  regarded,  however,  as  of  doubtful  utility.  Jamie- 
son  and  Haller  recommended  the  following : 

^.    Tr.  lodi,  3j. 

Acid.  Tannici,  3ss. 

Pulv.  Acaciae,  ,^ss. 
M.  (Hd.) 

Carbolic  Acid : — This  remedj'  is  also  emplo^^ed  to 
abort  the  formation  of  furuncles ;  it  is  condemned  by 
some  observers  when  used  alone  for  this  purpose. 
(B.  H.)  The  following  are  the  methods  of  its  appli- 
cation :  Inject  a  2  per  cent,  solution,  then  touch  the 
surface  with  the  pure  acid  and  cover  the  part  with  a 
carbolized  dressing,  or  heat  some  of  the  crystallized 
acid  on  the  point  of  a  probe  to  the  melting  point  and 
press  the  same  on  the  surface  of  the  furuncle.     (Sj.) 

The  following  is  very  effective : 

?fc.    Acid.  Carbolici,  gr.  v-x. 

Ext.  Ergotae,  3J-ij- 

Pulv.  Amyl, 

Zinc.  Oxidi,  aa  gij. 

Ung.  Aq.  Rosse,  ^ij. 

M. 

Take  a  piece  of  absorbent  cotten  several  times  the 
size  of  the  inflamed  surface,  and  spread  the  ointment 
on,  taking  care  that  no  pressure  is  made  to  hold  the 
plaster  in  place  except  at  the  edges.  This  will  afford 
marked  relief,  and  is  used  by  its  author  (Bulkley)  for 
boils  in  all  stages.  It  should  be  changed  every^  twelve 
hours.     (Bk.) 

Collodion: — At  the  pustular  stage  for  small  boils 
and  pimples,  emplo^^ed  on  account  of  its  contractile 
pow^er,  is  often  effectual  in  arresting  development. 
(Al.) 


BOILS.  79 

Resorcin: — A  thick  layer  of  the  ointment  made 
with  vaseline  has  good  effect  in  carbunculous  boils. 
(N.) 

Arnica: — The  tincture  or  extract  of  the  flowers  1 
part,  and  2  parts  of  honey,  with  an  inert  powder,  is 
used  ^nth  a  view  of  arresting.     (N.) 

Nitrate  of  Silver: — 5  to  20  grains  to  1  ounce  of 
nitrous  ether,  painted  on  to  abort,  is  specific  if  ap- 
plied early.  (R.)  See  also  Higginbottom's  method 
under  Abscess. 

Airol  : — A 10  per  cent,  gauze  has  proved  ver\^  effect- 
ive.    (T.,  98.) 

Opium  : — The  powdered  extract  mixed  to  the  con- 
sistency of  a  syrup  and  applied  several  times  a  day. 
(Al.) 

Pyoktanin  Blue: — As  this  agent  completely  arrests 
the  development  of  the  staphylococcus  aureus  it 
should  be  an  effective  application.  As  a  dressing  it  is 
commonly  employed  in  solutions  of  1-2000  to  1-100. 
As  an  ointment  in  strength  of  2  to  10  per  cent.  The 
deep  purple  stain  which  it  causes  on  the  skin  and 
linen,  and  which  constitutes  an  objection  to  its  use, 
may  be  removed  by  dilute  hydrochloric  or  nitric 
acid,  alcohol  or  cologne  water.     (F.) 

Belladonna  : — A  plaster  is  used  to  subdue  inflam- 
mation or  linen  soaked  in  a  solution  of  Atropine, 
gr.  iv-5J,  with  water  or  glycerine  for  the  relief  of 
pain  (R.)  or  on  the  ointment  with  equal  parts  of 
glycerine  spread  on  linen.     (Al.) 

Poultices  : — Hot  fomentations,  to  assist  matura- 
tion and  allay  pain,  should  generally  be  applied. 
They  may  be  sprinkled  freely  with  Tr.  Belladonna, 
or  Tr.  Opium.     (W.) 


80  DIGEST   OF   EXTERNAL    THERAPEUTICS. 

The  following  is  recommended  to  be  applied  to  the 
surrounding  skin  during  the  course  of  the  boil : 

5fc.    Acid.  Bond,  3J. 

Zinc.  Oxidi,  3J. 

Pul.  Amyli,  ^iij. 

Vaselini,  ^j. 
M.  (Hd.) 


BOWELS,     OBSTRUCTION      OF  —  IN- 
TUSSUSCEPTION —  F^CAL 
IMPACTION. 

The  radical  treatment  is  abdominal  section,  but 
inasmuch  as  non-surgical  measures  are  often  effect- 
ive they  should  be  employed  first. 

Morphine:  —  Hypodermically  administered  is  of 
great  service  for  the  relief  of  pain  and  spasm,  render- 
ing the  following  measures  more  efficient.     (Gn.) 

Gastric  Lavage  : — Affords  great  relief  to  the  inces- 
sant vomiting,  and  is  often  followed  by  reduction  of 
the  displacement ;  it  may  be  repeated  at  intervals  of 
six  hours.     (Gn.) 

High  Injections  : — If  the  cause  is  determined  to  be 
faecal  impaction  or  if  the  obstruction  is  in  the  large 
intestine,  copious  injections  should  be  tried,  using 
for  this  purpose  a  w^arm  saline  mixture  of  olive  oil, 
administered  by  means  of  a  fountain  syringe,  while 
the  patient  is  in  an  inverted  position.  The  abdomen 
should  be  well  kneaded,  and  the  body  well  shaken. 
The  injection  should  be  repeated  regularly.     (An.) 

Inflation  \vith  Hydrogen  Gas  or  Air: — If  injections 
fail,  two  or  three  gallons  of  the  gas  or  air  may  be 


BOWELS.  81 

carefully  introduced  (Senn)  from  a  large  rubber  bag. 
Thorough  manipulation  of  the  abdomen  may  be 
combined,  specially  if  there  is  intussusception.  In 
this  condition  inflation,  early  and  perseveringly  ap- 
plied, will  succeed  in  the  majority  of  instances.  (An.) 
Jonathan  Hutchinson  recommended  inflation  by 
warm  air  or  water,  administered  w^hile  the  patient 
is  in  the  knee  and  elbow^  position,  with  thorough 
kneading  of  the  abdomen.  This  method,  says 
Goodno,  is  not  without  risk  of  causing  perforation 
of  the  bowels. 

Enemata. 

Turpentine: — A  common  domestic  remedy  consists 
of  soap  suds  with  which  some  turpentine  has  been 
added. 

The  following  are  also  employed : 


?t. 

Ol.  Terebinthinae, 

IJ- 

Mucil.  Amyli  vel  Decoct.  Hordei, 

gxv. 

M. 

Or, 

• 

9^. 

Ol.  Terebinthinae, 

3ss. 

01.  Recini., 

giss. 

Ovi., 

No.  j. 

Decoct.  Hordei  vel  Aq.  Fervid., 

gxiv. 

M. 

(B.) 

Infus.  Lobelia: — Half  an  ounce  to  a  pint  of  hot 
water,  employed  for  the  relief  of  obstruction  arising 
from  intussusception,  strangulation  and  impaction. 
(F.) 

Infus.  Tobacco: — Half  a  drachm  to  a  pint  of  hot 
water,  macerate  for  six  hours  and  filter,  inject  one- 
quarter  to  one-half  the  quantity,  repeating  in  half  an 
hour,  if  necessary,  carefully  watching  its  effects. 
7 


82     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

(Sn. )    Tobacco  holds  a  secondary  place  as  an  anti- 
spasmodic,  and    care  is  necessary    to    avoid    toxic 
effects. 
Effervescent  Enemata  : — Are  prepared  as  follo^?vs : 

9;.    Sodii  Bicarb.,  3J. 

Aquae,  ,^viij. 

M. 

Inject  into  the  rectum,  and  immediately  follow 
with: 

ifc.    Pulv.  Acid.  Tartarici,  3j. 

Aquse,  ^viij. 

M.  (B.) 

Ox  Gall: — Injections  are  useful  for  the  relief  of 
faecal  impaction,  viz.: 

p.    Fellis  Bovis  Inspissant.,  ^iij- 

Glycerini,  ^ij. 

Acid.  Salicylici,  gr.  xv. 

Aquae,  q.  s.  ad  ^vj. 
M. 
Sig. — Use  in  quantities  of  one  >^  to  2  ounces,  mixed  with  soap 
suds.     (H.  F.) 

In  severe  cases  of  tympanitis  a  trocar  may  be  in- 
serted.    (An.) 

Intussusception  or  strangulation,  if  not  relieved 
w^ithin  twentj'^-four  hours,  demands  immediate  oper- 
ation, longer  delay  is  dangerous.  Early  operation 
gives  much  better  results  than  late.     (W.) 


BRAIN,  CONCUSSION   OF. 

The  symptoms  of  concussion  are  those  of  shock 
with  the  cerebral  symptoms  in  addition.  No  treat- 
ment is  called  for  in  the  early  states,  unless  the  col- 


BREASTS.  83 

lapse  is  very  alarmmg,  when  stimulants  will  be  nec- 
essary, but  they  are  not  indicated  in  cases  of  average 
severity.  The  tendency  to  death  in  pure  concussion 
is  from  syncope  and  shock  causing  failure  of  the 
heart  action.  The  administration  of  stimulants  in 
these  conditions  should  be  such  as  will  be  least  liable 
to  provoke  inflammation. 

The  patient  should  be  placed  in  a  warm  bed  with 
the  head  at  first  moderately  low.  Heat  should  be 
applied  to  the  axillee  and  extremities.  Absolute  quiet 
must  be  enjoined  and  no  attempt  should  be  made  to 
arouse  to  consciousness,  nor  food  or  drink  adminis- 
tered. If  depression  be  prolonged  mild  stimulants, 
such  as  ammonia,  w^ill  be  called  for,  and  in  extreme 
cases  stimulating  enemata  may  avert  impending 
death.  Great  firmness  is  often  necessary  to  with- 
stand the  urgent  demands  of  friends  for  expectant 
measures.  When  reaction  appears  the  head  and 
shoulders  should  be  raised  a  little  and  cold  appli- 
cations and  evaporating  lotions  applied.  The  apart- 
ment of  the  patient  should  be  cool  and  carefully 
guarded  from  noise  and  the  light  modified.  Conver- 
sation around  or  near  him  must  be  avoided.  After 
recovery  he  must  be  kept  under  observation  for  two 
or  three  v^eeks  lest  some  insidious  inflammation  de- 
velop.    (Rd.) 


BREASTS,  SWOLLEN   AND  PAIN- 
FUL—INFLAMMATION OF. 

Collodion : — An  application  covering  the  entire 
breast,  will  often  relieve  congestion  and  prevent  sup- 
puration.    (F.) 


84-  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Camphorated  Oil  or  Camphor  and  Lard: — 3J— sj, 
rubbed  in  gently  will  sometimes  abort  suppuration. 
(Bt.) 

Roller  Bandage: — Snugly  applied  around  the  body 
so  as  to  give  firm  support,  will  arrest  the  formation 
of  an  abscess.     It  should  be  reapplied  daily.     (Ga.) 

Massage  and  Evacuation  : — Rub  gently  in  the  di- 
rection of  the  nipple,  and  evacuate  with  breast- 
pump.     (Sj.) 

Olive  Oil : — As  soon  as  hardness  appears  rub  with 
the  oil  from  circumference  to  centre,  and  support  the 
breast  with  a  sling  made  of  a  broad  handkerchief. 
(Ga.) 

Belladonna  Ointment : — Applied  on  lint  and  cov- 
ered with  linseed  meal  poultices,  if  used  as  soon  as 
an  inflammatory  blush  appears,  -will,  as  a  rule,  cause 
all  traces  of  inflammation  to  disappear  in  twenty- 
four  hours.    (T.,  97.) 

Stramonium: — The  leaves  as  a  fomentation  are 
effective  as  an  anodj^ne  for  engorged  breasts.     (Sn.) 

Phytolacca  Dec: — The  tincture  sprinkled  on  hot 
flannels  (Ga.),  or  the  following  ointment: 

ffc.    Pulv.  Phytolaccse  Rad.,  3J- 

Camphorse,  gr.  x. 

Ext.  Belladonnse,  3J- 

Ung.  Zinc.  Oxidi  Benzoat.,  5J- 

M.  (Sm.) 

Phosphatad  Oil : — Applied  w^ith  cloths,  and  gently 
rubbed  in.  Ammon.  Carb.: — 5i~QJ»  compresses  well 
saturated  wath  the  solution,  if  applied  earlj^  Avill 
prove  very  satisfactory.  Chloroform  and  Glycer- 
ine: —  Equal  parts.  Castor  Oil  and  Glycerine:  — 
Equal  parts;  very  soothing.  Hamamelis  : — Applied 
on  compresses.     ( Bt. ) 


BREASTS.  85 

Spts.  Vini  Rect.: — When  the  skin  is  tense  and 
hard,  and  the  veins  distended,  sponge  the  parts  until 
quite  cold,  repeating  as  soon  as  heat  returns.  A  few 
spongings  will  afford  relief.     (Rd.) 

Heat : — Applied  by  means  of  a  bowl  lined  w^ith 
flannel  saturated  with  hot  water  and  placed  over 
the  left  breast,  is  one  of  the  most  effective  means  of 
relieving  pain  and  preventing  suppuration.     (Rd.) 

The  following  lotions  are  used:  Aconitine  (with 
caution),  Atropine,  Pilocarpine,  each  in  the  propor- 
tion of  1  grain  to  the  ounce.     (Bt.) 

When  pus  has  formed  it  must  be  evacuated  under 
strict  antisepsis.  The  part  must  be  washed  with  a 
solution  of  bichloride  and  an  incision  made  radiat- 
ing from  the  nipple.  A  director  should  be  inserted, 
and  any  pockets  of  pus  searched  out  and  the  walls 
broken  through.  After  evacuation  the  abscess  cavity 
may  be  irrigated  with  an  antiseptic  solution,  such  as 
Creolin  2  per  cent.,  or  Hydrogen  Peroxide  pure,  or 
a  weak  solution  of  Bichloride  of  Mercury.  After  ir- 
rigation aseptic  gauze  with  gentle  pressure  should 
be  applied.     (Am.) 

Strapping  : — Equal  pressure  applied  by  means  of 
straps  of  adhesive  plaster  will  prove  of  great  benefit 
in  old  cases.  If  there  are  sinuses  first  inject  them 
with  an  antiseptic  solution. 

Ammon.  Chloride: — 1  ounce,  w^ith  spts.  of  rose- 
mary 1  pint,  kept  constantly  applied  by  means  of 
compresses,  is  useful  for  the  induration  follow^ing 
suppurative  mastitis.     (Al.) 


86  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


BREATH,    OFFENSIVE. 

The  condition  of  the  teeth,  stomach,  mucous  mem- 
brane of  the  throat,  nose,  and  lungs  should  receive 
attention. 

The  following  used  as  mouth  washes  are  of  service 
(B.)  (N.)  (Sm.): 

Hydrogen  Peroxide,  5J,  water  giij. 

Tr.  Myrrh,  gj,  water  giij. 

Potass.  Chlorate,  5],  water  §iv. 

Potass.  Permang.: — Gr.  j,  rose  water  .^j. 

The  following  combinations  w^ill  prove  useful : 

^.    Calcis  Chlorat.,  .^iij- 

Aquae, 
Alcohol.,  aa  ^ij. 


01.  Rosae, 

gtt.  iv. 

M. 

Sig. — I  teaspoonful  in  a  glass  of  water. 

(B.) 

Or, 

^.    Sod.  Biborat., 

3J- 

Tr.  Myrrhae, 

^ss. 

Glycerini, 

^j- 

Aquae, 

|iv. 

M. 

Or, 

5fc.    Acid.  Thjmici, 

gr.  iv. 

Acid.  Benzoici, 

gr.  xiv. 

Tr.  Eucalypti, 

f  ss. 

Alcohol.  Absoluti, 

^iij- 

01.  Gaulther., 

gtt.  XXV. 

M. 

Sig. — I  or  2  teaspoonfuls  in  half  a  glass  of  water.     (Sm.) 

Solutions  of   Boric  or  Salicylic  Acid,   Charcoal, 
Camphor,  and  Naphthol  are  also  used. 


BROMIDROSIS   AND   HYPERHIDROSIS.  87 


BROMIDROSIS  AND  HYPERHIDROSIS. 

In  the  former,  frequent  ablutions  are  necessary ;  in 
the  latter  wash  as  little  as  is  compatible  with  clean- 
liness. Applications  are  made  in  the  form  of  pow- 
ders, lotions,  and  ointments ;  as  a  rule  powders  are 
preferable . 

Powders. 

Aristol: — Will  restrain  profuse  perspiration  either 
alone  or  in  combination  with  boric  acid  or  impure 
zinc  carbonate.     (Sm.) 

Boric  Acid : — For  the  feet ;  soak  the  stockings  in  a 
saturated  solution,  allow  them  to  dry,  then  wear 
thus  impregnated  with  the  acid.     (F.) 

Chloral  Hydrate: — 1  drachm,  with  starch  1  ounce 
constitutes  one  of  the  best  powders.     (Vn.) 

/?-Naphthol: — 15  grains,  with  bismuth  1  ounce  or 
20  grains,  with  boric  acid  4  drachms.     (Sm.) 

Dermatol,  20  parts. 

Starch,  10  parts. 

Talc,  70  parts. 

(Sm.) 

Salicylic  Acid: — The  fine  pow^der,  dusted  over  the 
feet  and  stockings,  is  very  effective  (B.);  also  the  fol- 
lowing combination : 

ifc.    Pulv.  Acid.  Salicylici, 

Pulv.  Zinc.  Carbonat.  Praecipitat, 

Pulv.  Magnesii  Ust.,  aa  ^iv. 

Pulv.  Amyli,  3xv. 

Pulv.  Talci,  3  XX. 

M.  (Vn.) 

Tannin: — The  following  is  a  good  astringent: 


88  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

9.    Acid.  Tannici,  3J. 

Lycopodii,  ^j. 

M.  (Sm.) 

Tartaric  Acid : — Has  proved  efficacious  in  the  treat- 
ment of  fetid  sweating  of  the  feet.  A  pinch  of  the 
powdered  acid  is  dusted  every  day  in  the  socks  and 
betw^een  the  toes,  and  the  erosions  which  ma\'  exist 
in  these  places  are  covered  with  small  pieces  of  cotton 
charged  with  boric  acid  ointment.     (Rr.) 

Lotions. 

Alum: — .5j—ij,  water  Oj.     (Sh.) 

Alcohol  and  Boroglyceride  (50  per  cent.): — Equal 
parts.     (Sm.) 
Boric  Acid: — Saturated  solution.     (Ja.) 
Hydrastine  Muriat.: — Gr.  ij-vj,  water  ^j-     (F.) 
Salicylic  Acid: — 3  per  cent,  solution.     (Ja.) 
Chromic  Acid: — A  5  to  10  per  cent,  solution  ap- 
plied once  or  twice  in  from  two  to  four  wrecks  is 
effective  in  bromidrosis  of  the  feet.    The  same  solu- 
tion is  recommended  by  Prof.  Richter,  viz.:   Applica- 
tions are  made  every  five  days  to  the  palms  of  the 
hands  and  to  the  inter-digital  surfaces,  taking  care 
each  time  to  allow  the  parts  to  drj^  thoroughly. 
The  yellow  color  of  the  skin  disappears  by  washing 
a  few  times,  without  ill  effects  of  any  kind.    Any  ex- 
isting fissures  ought  to  be  cured  by  applications  of  a 
10  per  cent,  salicylated  soap  plaster  before  beginning 
the  treatment  of  the  hyperhidrosis  itself.     Ten  appli- 
cations of  the  chromic  acid  solution  are  generallj'- 
sufficient  to  effect  a  cure. 

Sulphate  of  Copper: — 1  grain,  with  hamamelis  1 
ounce.     (Sm.) 
Naphthol: — 5  per  cent,  solution  in  alcohol  for  bath- 


BROMIDROSIS   AND    HYPERHIDROSIS.  89 

ing  the  parts,  or  the  powder  of  1  per  cent,  with 
starch.     (Kap.) 

Hydrarg.  Bichlorid.: — Gr.  x,  cologne  w^ater  or  tinct- 
ure of  hamamehs  ^iv.     (Sh.) 

Lead  Acetat.: — 3ij-iij,  water  Oj.     (Al.) 

lufus.  White  Oak  Bark.     (Kp.) 

Infus.  Quillaia: — As  a  wash  for  the  hands  and  feet 
once  daily.     (Sm.) 

Potass.  Permang.: — Gr.  j— v  to  water  |j,  useful  for 
sponging  the  feet ;  afterwards  dust  with  the  powder 
of  salicylic  acid  and  starch.  This  will  often  correct 
the  condition.     (Sm.) 

Zinc: — The  oxide  with  starch.  (Kp.)  The  oleate 
gr,  iij,  starch  gss,  or  the  compound  stearate  with 
boric  acid.     (Sm.) 

Ointments. 

These  are  not,  as  a  rule,  suited  for  use  on  the  hands 
or  feet,  powders  and  lotions  being  preferable;  in 
obstinate  cases,  however,  they  may  be  used  with 
benefit. 

Ung.  Hydrarg.  Oleat.: — 10  per  cent,  for  the  axillge, 
the  skin  being  previously  washed  with  alcohol.     (N.) 

Aluminum  Oleate: — Diluted  one-half  with  lard  or 
some  other  fatty  substance,  forms  the  ointment  of 
the  oleate  of  aluminum  w^hich  is  very  effective.    (Sm.) 

Ung.  Picis.:— Equal  parts  with  Ung.  Sulphur. 
(Vn.) 

Hebra's  Treatment: — For  obstinate  and  severe 
forms  of  sweating  of  the  soles  of  the  feet  and  the 
hands ;  take  equal  parts  of  olive  oil  and  diachylon 
ointment,  melt  the  ointment,  and  add  the  oil,  stir- 
ring until  a  homogeneous  mass  results ;  cut  pieces  of 
muslin  the  size  of  the  part,  and  spread  on  the  oint- 


90  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

ment  thickly,  and  apply.  Lint  spread  with  the  oint- 
ment should  also  be  placed  between  the  toes  or 
fingers  and  a  roller  bandage  firmly  applied  over  all. 
These  dressings  should  be  changed  twice  in  twenty- 
four  hours,  and  the  parts  rubbed  dry  with  lint  and 
starch  powder  without  washing.  This  treatment 
should  be  continued  fi-om  one  to  several  wrecks,  ac- 
cording to  the  severity  of  the  disease.  After  the  dis- 
continuance of  the  ointment  the  pow^der  should  be 
applied  for  several  weeks.     (Vn.) 

Pilocarpine : — Small  doses  hypodermically  have 
proved  benefici  al .     ( Sm . ) 

Sea  Baths  or  Salt  Baths  are  sometimes  of  service. 
Carbolic,  Juniper  Tar,  Eucalyptus  and  Ichthyol 
Soaps. 

Disinfection  of  the  shoes  is  an  indispensable  pre- 
caution to  prevent  the  recurrence  of  the  bromidrosis. 
This  is  done  by  pouring  into  the  shoe  a  mixture 
of  1  tablespoonful  of  commercial  formalin  to  1  litre 
of  water,  or  a  3  per  cent,  solution  of  carbolic  acid ; 
the  liquid  is  left  for  a  few  hours,  after  which  it  can  be 
dried  rapidly.     (Rr.) 


BRONCHITIS. 

ACUTE  BRONCHITIS. 

The  patient  should  be  propped  well  in  bed,  as  posi- 
tion influences  stasis  of  the  blood  in  the  lungs.  (Rd.) 

Sinapisms,  or  Turpentine  Embrocations  :  —  Ap- 
plied to  the  anterior  surface  of  the  chest  will  relieve 
cough  and  oppression.     (Ty.) 

Lin.  Camphor.  Comp.: — Systematically  and  thor- 


CAPILLARY    BRONCHITIS.  91 

oughly  applied  with  massage,  is  said  to  be  ven'  help- 
ful in  relieving  the  sense  of  constriction  and  uneasi- 
siness.     (T.,  97.) 

Vini  Ipecac:  —  Diluted  with  twice  its  bulk  of 
water  sprayed  into  the  throat  night  and  morning 
for  about  ten  minutes,  the  patient  expectorating  the 
liquid  as  it  accumulates,  is  recommended  to  relieve 
distressing  cough,  labored  breathing  and  sense  of 
constriction.     (T.,  97.) 

Inhalations  of  the  vapor  of  a  saturated  solution 
Amnion.  Chloride  or  Tr.  Benzoin.  Comp.  poured  on 
the  surface  of  hot  water  are  useful  palliatives  w^hen 
there  is  decided  oppression.     (Ty.) 

CAPILLARY  BRONCHITIS. 

Counter-irritation  by  sinapisms,  or  Turpentine,  is 
especially  useful.  The  former  may  be  made  w^ith 
about  1  part  to  5  or  6  of  flaxseed  meal,  and,  if  the 
white  of  one  egg  and  glycerine  is  used  instead  of 
water,  it  may  be  kept  applied  much  longer.  Turpen- 
tine may  be  applied  in  the  combination  kno^wn  as 
St.  John  Long  Liniment,  which  consists  of  a  tea  cup 
of  vinegar  and  a  wineglassful  of  turpentine  beaten 
up  with  one  egg.  Rub  on  the  chest  and  apply  with 
flannel.  This  is  said  to  be  the  most  effective  way  in 
which  to  apply  turpentine.     (Ty.) 

Poultices : — These  are  now  generally  condemned 
on  account  of  their  weight  and  the  exposure  in 
changing.  They  are,  however,  recommended  by 
some  writers  for  capillary  bronchitis  in  children. 

CHRONIC  BRONCHITIS. 
The  inhalation  of  medicated  vapors  is  often  em- 


92  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

ployed    with    satisfactory'    results.     The    following 
remedies  are  thus  used : 

9;.    Tr.  Benzoin.  Comp.,  5J- 

Aq.  BuUientis,  Oj. 
M. 

Sig. — Inhale  vapor  night  and  morning.  (Sm.) 

9:.     Acidi  Carbolici,  gtt.  iij-vj. 

Aq.  Bullientis,  Oss. 

M.  (Al.) 

Iodine  : — Combined  with  turpentine  as  follow^s, 
form  an  excellent  mixture,  non-irritating  to  the 
mucous  membrane:  Iodine  10  parts,  alcohol  20 
parts,  mix  in  a  flask,  and  add  essence  of  terebinth 
20  parts,  and  spirits  of  lavender  10  parts.  Shake 
the  mixture  well.  It  will  be  found  useful  when  ex- 
pectoration is  profuse  and  fetid.     (Sm.) 

Ethyl  Iodide: — 10  to  30  minims  will  afford  marked 
relief  to  the  cough,  and  is  the  most  direct  method  of 
introducing  iodine  into  the  system.     (Sm.) 

Terebene  : — 5  to  40  drops  to  1  ounce  of  water 
w^ith  20  grains  of  carbonate  of  magnesia;  a  tea- 
spoonful  of  the  mixture  is  added  to  a  pint  of  w^ater 
at  a  temperature  of  140°,  and  the  vapor  inhaled  for 
ten  minutes  night  and  morning.     (Al.) 

Turpentine: — 5  minims  of  the  oil  to  a  pint  of 
water  at  150°.     (Al.) 

Creosote  : — 5  to  6  minims  with  a  little  carbonate 
of  magnesia  added  to  a  pint  of  hot  water  forms  an 
inhalation  which  is  indicated  when  there  is  dilata- 
tion of  the  bronchi  and  retention  of  mucus.     (Al.) 

Sulphurous  Acid: — In  sprays,  or  "  Pictet  Liquid," 
the  latter  is  a  combination  of  sulphurous  and  car- 
bonic acid  gas  liquified  bj^  a  pressure  of  three  atmos- 
pheres.    It  is  stored  in  syphons  and  is  a  very  pow^er- 


BRONCHIECTASIS.  93 

ful  agent.  It  must  be  inhaled  with  very  great  cau- 
tion. Carpets,  furniture,  hangings,  bedding,  etc., 
must  be  removed  and  nothing  left  in  the  room  but  a 
chair  and  a  table.  The  slightest  pressure  on  the 
valve  of  the  syphon  will  permit  the  escape  of  the  gas 
in  minute  quantities  until  the  desired  amount  is  ob- 
tained, the  patient  being  the  best  judge.  A  peculiar 
brass3^  taste  with  a  slight  sense  of  constriction  of 
the  throat  and  a  little  cough  and  feeling  of  oppres- 
sion are  the  effects  to  be  obtained  and  kept  up  for  an 
hour  or  two.  It  is  claimed  that  if  administered  with 
due  caution  excellent  results  are  to  be  expected.  (B.) 
Carbolic  Acid  and  Eucalyptus : — For  inhalation 
when  the  expectoration  is  very  fetid  : 

9;.    Acid.  Carbolici,  gr.  ij-iv. 

Ol.  Eucalypti  J  M  ij-iv. 

Aquae,  gj. 

M.  (An.) 

Sig. — To  be  inhaled  from  a  steam  or  hand  atomizer  three  or  four 
times  a  day. 

Olive  Oil  Inunctions  to  the  chest  are  often  sooth- 
ing and  strengthening.     (Rd.) 


BRONCHIECTASIS. 

Antiseptic  sprays  and  inhalations,  as  mentioned  in 
the  previous  article  and  in  the  article  on  Pulmonary 
Tuberculosis,  are  applicable. 


94  DIGEST   OF   EXTERNAL   THERAPEUTICS. 


BUBO. 

Preventive  Treatment. 

When  suffering  from  gonorrhoea,  chancroid  or  any 
lesion  liable  to  cause  bubo,  physical  exertion  should 
be  avoided  as  much  as  possible. 

Cleansing  and  Dressing  of  Venereal  Ulcerations : 
— All  sores  should  be  thoroughly  cleansed.  As  sprays 
penetrate  more  deeply  and  irritate  less  than  washes, 
antiseptic  lotions  are  better  applied  that  way.  Solu- 
tions of  Carbolic  Acid  1-100,  Hydrogen  Peroxide 
half  strength,  and  Nitrate  of  Silver  1-100  in  normal 
saline  solutions,  are  suitable  antiseptics.  The  lesions 
may  first  be  sprayed  with  the  peroxide,  then  with 
one  of  the  other  solutions. 

If  there  is  much  secretion  Black  Wash,  or  some 
other  wet  dressing  may  be  applied  and  renewed  after 
each  urination.  If  the  discharge  is  not  copious  dust- 
ing powders  are  preferable,  viz.:  Acetanilid,  Airol, 
Iodoform,  etc.  When  drainage  is  impossible  on  ac- 
count of  a  contracted  and  elongated  foreskin  circum- 
cision should  be  performed.     (T.,  97.) 

Abortive  Treatment. 

When  inflammation  has  commenced  Rest  in  bed 
and  Cold  Applications  are  of  great  importance.  (CI.) 

Collodion: — Painted  on  the  part  causes  contrac- 
tion and  pressure,  and  is  especially  serviceable  when 
it  is  impracticable  for  the  patient  to  remain  quiet. 
(CI.) 

Pressure : — A  ball  of  cotton  as  large  as  a  man's 


BUBO.  95 

fist  is  placed  over  the  gland,  and  bound  down  by  a 
firmly  applied  spica  bandage.  A  few  safety  pins  are 
placed  in  the  bandage  through  the  ball  to  prevent 
slipping.  This  simple  measure  is  often  very  success- 
fill.     (T.,  97.) 

Phytolacca  Dec.: — The  tincture  or  fld.  ext.  on  cot- 
ton.    (Rd.) 

Nitrate  of  Silver: — A  2  per  cent,  solution  injected 
in  the  early  stages. 

Carbolic  Acid : — A  2  per  cent,  solution  by  injection. 

(F.) 

The  following  other  measures  have  been  suggested, 
some  of  which  are  better  adapted  to  hospital  prac- 
tice: 

If  the  bubo  is  seen  within  the  first  twenty-four  or 
forty-eight  hours  of  its  becoming  painful,  the  foUow^- 
ing  may  be  tried  to  prevent  extension :  Place  the  pa- 
tient in  bed  after  a  saline  purge  and  apply  over  the 
bubo  a  compress  consisting  of  eight  or  ten  layers  of 
gauze  soaked  in  a  dilute  solution  of  acetate  of  lead, 
and  a  spica  bandage  over  this.  The  compress  should 
be  kept  wet  with  the  lead  solution  for  twenty-four 
hours ;  if  there  is  no  improvement  at  the  end  of  that 
time,  the  bubo  should  be  dissected  out  and  the  inci- 
sion closed  without  drainage.  To  accomplish  this 
successfully  all  suppurative  lesions  of  the  penis  must 
be  thoroughly  cleansed  and  the  organ  enclosed  in  an 
antiseptic  dressing.  The  skin  over  the  bubo  must  be 
prepared  as  if  for  a  major  operation.     (T.,  97.) 

Mercury  Benzoate: — Hypodermic  injections  of  this 
salt  at  one  or  tw^o  points  were  used  for  the  treat- 
ment of  threatened  suppuration  in  thirty-three  cases, 
thirty  of  which  were  successful.  The  amount  injected 
was  71/2  minims  of  a  fluid  composed  of  a  1  per  cent. 


96  DIGEST   OF  EXTERNAL  THERAPEUTICS. 

solution  of  mercurj'  benzoate,  and  a  V2  per  cent,  solu- 
tion of  sodium  chloride.  It  is  claimed  that  any  mer- 
curial salt  would  accomplish  the  same  purpose.  The 
sodium  chloride  is  necessary  for  the  solution  of  the 
benzoate  of  mercur\'.     (Sm.) 

When  Suppurating-. 

Method  of  Fontau: — The  following  is  recommended 
as  most  effective  for  suppurating  bubos,  reports  of 
which  give  very  favorable  results.  The  skin  for  some 
eight  or  ten  inches  about  the  part  is  scrubbed  with 
green  soap,  ^vashed  with  ether,  and  then  with  bi- 
chloride 1-1000.  A  narrow^  bistoury  is  then  inserted 
into  the  abscess  cavity,  the  contents  of  \vhich  are 
gently  expressed.  The  cavity  is  then  irrigated  with 
the  bichloride  1-1000,  and  at  once  filled  to  moderate 
distension  with  warm  iodoform  ointment  (10  per  . 
cent,  iodoform,  90  per  cent,  vaseline).  Caution 
should  be  exercised  not  to  use  too  much  heat  in 
w^arming  the  ointment  lest  the  iodine  be  liberated. 
An  ordinary  cone-pointed  glass  syringe  may  be  used 
for  the  introduction  of  the  ointment ;  the  plunger  is 
removed  and  the  barrel  warmed  and  filled  by  means 
of  a  spatula.  Immediately  on  withdrawing  the 
syringe  a  compress  wet  with  a  cold  bichloride  solu- 
tion is  applied  and  the  melted  ointment  instantly 
solidifies  at  the  orifice  and  its  escape  is  prevented 
firom  the  cavity.  A  large  compress  of  sterilized  gauze 
is  then  applied  by  means  of  a  firm  spica  bandage. 
The  patient  should  report  at  the  end  of  four  days, 
when,  if  all  is  well,  the  dressing  is  reapplied,  but  if 
there  is  any  evidence  of  inflammation  the  wound  is 
thoroughly  irrigated,  cleansed  and  the  injection  re- 
peated.   The  advantages  of  this  procedure  are:   1. 


BUBO.  97 

Simplicit\^  and  safety ;  2.  Rapid  cure;  3.  The  patient 
can  go  about  when  under  treatment;  4.  The  first 
gland  being  rendered  aseptic  others  are  less  likely  to 
become  affected,  5.  No  scar;  6.  Does  not  interfere 
with  another  surgical  procedure  should  any  be  neces- 
sary subsequently.  The  method  is  only  applicable 
when  there  is  infection  by  the  staphylococcus  and 
when  there  is  an  appreciable  pus  cavity.  In  diffuse 
phlegmon  with  no  pus  ca^aty  the  treatment  has  not 
been  found  available.     Q.  C.  G.,  5,  93.) 

Excision: — The  following  plan  has  been  employed 
with  success :  The  overlying  skin  is  prepared  in  the 
usual  manner  as  for  a  capital  operation.  The  in- 
flamed gland  is  cut  down  upon,  dissected  out  and 
removed  and  all  the  vSurrounding  necrotic  tissue  re- 
moved by  a  sharp  curette,  the  removal  of  this  tissue 
must  be  as  thorough  as  possible.  The  cavity  is  then 
irrigated  with  hot  sterilized  v^ater  and  packed  for  a 
few^  moments  with  hot  moist  sterile  gauze  to  remove 
loose  debris  and  check  oozing.  All  suspiciously 
necrotic  looking  skin  should  be  removed ;  the  gauze 
pack  is  then  taken  out  and  the  whole  cavity  is 
packed  full  with  powdered  boric  acid  ;  the  incision  is 
then  closed  wdth  interrupted  sutures.  No  drainage  is 
required  except  in  neglected  cases.  When  the  cavity 
is  the  size  of  a  duck's  egg,  the  surface  about  the  inci- 
sion is  dusted  with  boric  acid  and  very  firm  pressure 
applied  by  means  of  a  well-adjusted  compress  of 
sterilized  gauze ;  over  this  a  spica  bandage.  Cure  may 
be  expected  in  from  four  to  eleven  daj^s.     (T.,  97.) 

Another  method  of  treatment  consists  in  incisions 
as  described  in  the  treatment  of  Fontau,  and  the  in- 
troduction of  a  piece  of  Carbolized  or    Iodoform 
Gauze  through  the  incision,  and  allowing  the  pus  to 
8 


98     DIGEST  OF  EXTERNAL  THERAPEUTICS. 

drain  off.  If  after  evacuation  the  skin  over  the  cavity 
becomes  sunken  and  shriveled  it  should  be  removed 
and  the  bubo  treated  like  an  ulcer  as  the  conditions 
indicate.     (CI.) 

Xeroform  : — After  a  preliminary  cauterization  with 
carbolic  acid,  applied  as  a  powder  will  promote  heal- 
ing and  lessen  suppuration.     (F.) 

Silica  Hydrate  : — Pack  the  bubo  with  the  remedy, 
renewing  it  once  or  twice  a  day.  It  wall  check  sup- 
puration A'ery  quickly,  but  should  not  be  used  too 
long,  as  it  devitalizes  the  tissues  and  leads  to  exten- 
sive sloughing.     ( F. ) 

Ammon.  Chloride  : — ^^ij— §j  in  hot  water  useful  for 
indolent  types.    (Al.) 

Sanoform : — Less  effective  than  iodoform,  but  gives 
good  results  when  used  as  a  substitute.  It  has  the 
advantage  of  being  free  from  odor.     (F.) 

Nitrate  of  Silver: — The  cra^^on  lighth'  applied  to 
the  surface  of  indolent  bubos  and  to  the  cavities  of 
sinuses  is  useful  for  stimulation.  A  solution  of  3J— 5j 
followed  by  iodoform  gauze  packing  may  be  em- 
ployed for  the  same  purpose.     (Al.) 

Hot  Fomentations  : — When  suppuration  is  inevita- 
ble, to  hasten  maturation.     (CI.) 


BUNION. 

In  recent  cases,  the  sac  being  thin,  it  may  be  rup- 
tured by  pressure,  the  contents  evacuated  and  the 
condition  corrected.  In  time  the  cyst  becomes  thick- 
ened and  this  proceeding  will  no  longer  be  effective. 
In  this  case  the  direction  of  the  toe  must  be  changed 


BURNS  AND  SCALDS.  99 

by  wearing  properly  shaped  boots  made  with  the  in- 
ner side  of  the  sole  straight  from  the  sole  to  the  heel. 
(Rd.) 

If  the  bunion  is  discharging  use  stimulating  appli- 
cations; if  there  is  inflammation,  poultices  and 
soothing  remedies. 

"Warm  Foot  Baths  : — Very  serviceable  for  the  relief 
of  irritation  of  the  part.     (Rd.) 

Lotions  of  Tr.  Arnica,  gtt.  xx-gss,  or  Tr.  Ruta, 
same  strength  when  there  is  any  tendency  to  ery- 
sipelas, after  foot-baths.     (Rd.) 

Verat.  Vir.: — Equal  parts  of  the  tincture  with 
spirits  of  wine  and  water  w^hen  there  is  much  inflam- 
mation.    (C.) 

Copper  Oleate  :— A  10  to  20  per  cent,  ointment 
spread  on  as  a  plaster  will  often  relieve.     (Sm.) 

Calendula  : — 1  part  of  the  succus  to  10  of  w^ater 
w^hen  suppurating.  Tr.  Iodine  andTr.  Belladonna : — 
Equal  parts,  apply  twice  daily. 

Poultices  are  indicated  when  pus  has  formed.  (Rd.) 


BURNS  AND  SCALDS. 


Whatever  form  of  dressing  is  employed  any  degree 
of  pressure  to  the  burned  surfaces  must  be  avoided. 
If  the  posterior  surfaces  of  the  body  or  limbs  are  in- 
volved the  patient  must  lie  prone.    (W.) 

Orthoform  : — This  local  anaesthetic  has  proved  a 
most  effective  remedy  for  the  relief  of  the  pain  of 
bums.  It  may  be  dusted  on  the  denuded  surface  or 
applied  in  the  form  of  10  to  20  per  cent,  ointment 


100         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

with  lanolin.     It  does  not  in  any  way  interfere  wdth 
the  normal  reparative  process. 

Carbolic  Acid  : — This  is  one  of  the  first  remedies;  it 
is  used  mixed  with  olive  oil.  A  piece  of  lint  being 
soaked  in  the  carbolized  oil  is  applied  directly  to  the 
w^ound.  It  is  recommended  in  the  proportion  of  1 
part  of  the  acid  to  50  of  olive  oil  (W.)  and  in  much 
stronger  mixtures,  such  as  1  part  to  12.  (Ga.)  The 
follow^ing  are  useful  formulas  for  its  adaptation : 


9;.    Acid.  Carbolici, 

3iss. 

Glycerini, 

gss. 

Aq.  Destill., 

ad  5vj. 

M. 

(Rd.) 

Or, 

^.    Acid.  Carbolici, 

gr.  viij. 

Vaselini, 

Sij- 

M. 

Sig.     Spread  on  lint. 

(Bellevue  Hospital.) 

Or, 

9;-    Acid.  Carbolici, 

gr.  XV. 

Liq.  Calcis, 

01.  Lini, 

aa  gij. 

M. 

Sig.     Wring  out  cloths  saturated 

in  the  mixture  and  apply. 

( City  Hospital. ) 

Picric  Acid: — A  simple  and  satisfactory  remedy  for 
superficial  bums  and  scalds.  A  solution  is  made  as 
follows :  Picric  acid  siss,  alcohol  giij  ;  allow  the  acid 
to  dissolve,  then  add  2  pints  of  distilled  Avater.  The 
burned  surfaces  should  be  cleansed  with  absorbent 
cotton  dipped  in  the  solution  and  the  blisters  pricked  ; 
care  should  be  taken  not  to  destroy  the  epithelial 
surfaces ;  strips  of  sterilized  gauze  are  soaked  in  the 
solution  and  applied  so  as  to  cover  the  entire  injured 


BURNS  AND  SCALDS.  101 

surface,  and  the  Avhole  kept  in  place  b^'  a  bandage. 
The  dressing,  which  soon  dries,  is  left  in  place  for 
three  or  four  days ;  it  is  then  removed  by  saturating 
with  the  picric  acid  solution.  The  second  dressing  is 
applied  as  the  first  and  left  on  for  a  week.  The  ad- 
vantages of  this  treatment  are  that  it  seems  to  re- 
lieve the  pain,  and  limits  the  tendency  to  suppura- 
tion by  coagulating  the  albuminous  exudations. 
Healing  takes  place  under  a  scab,  and  a  smoother 
and  more  supple  cicatrix  results  than  by  other 
methods.  (T.,  97.)  Solution  of  other  strengths  are 
also  employed,  as  1-200,  which  is  described  as  anti- 
septic, analgesic,  and  keratogenous,  and  free  from 
accidents  provoked  bj^  other  antiseptics.  Saturated 
solutions  are  also  recommended.     (Sj.) 

Carbonate  of  Lead: — Used  either  pure  or  w^orked 
up  with  oil  to  the  consistency  of  cream ;  it  should 
not,  how^ever,  be  applied  to  large  surfaces  for  fear  of 
toxic  effects.  This  remedy  w^as  favorably  regarded 
by  the  late  Dr.  Gross.     (Al.) 

Sodium  Carbonate: — Saturated  solutions  for  the 
relief  of  pain.     (B.) 

Carron  Oil: — Made  by  mixing  equal  parts  of  lime 
w^ater  and  linseed  oil  is  an  old  and  well-tried 
remedy;  it  was  used  carbolized  by  Dr.  Gross.  (T., 
96.) 

Flour:  —  Dusted  on  thickly,  or  flour  and  lard 
worked  up  together.     (Ga.) 

Airol: — A  dusting  powder  rapid  in  effect  and  un- 
irritating.     (Sj.) 

Guaiacol : — Interstitial  injections  of  a  1-10  or  a  1- 
20  solution,  a  Pravaz  S3^ringeful,  affords  relief.  The 
action  is  slower,  but  more  lasting  than  that  of 
cocaine.     (Sj.) 


102  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Nutgalls: — 1  part  of  the  powder  and  8  parts  of 
borated  vaseline  for  diminishing  over-abundant  sup- 
puration, and  as  a  deodorant.     (Sj.) 

Ichthyol : — In  bums  of  the  first  and  second  degree, 
as  long  as  the  blisters  are  small  and  intact,  strong 
solutions  have  been  found  of  great  benefit  in  reliev- 
ing pain  and  congestion,  and  when  applied  early  will 
sometimes  even  prevent  the  formation  of  blisters.  If, 
how^ever,  the  surface  is  eroded  strong  solutions  will 
cause  irritation  and  inflammation.  (F.)  Equal  parts 
with  water  have  been  used  as  soon  as  the  denuded 
skin  is  removed  and  some  of  the  inflammation  has 
subsided.  A  25  per  cent,  ointment  kept  continuously 
applied  is  also  employed. 

Thiol: — An  excellent  remedy  in  burns  of  all  de- 
grees ;  it  is  employed  with  occlusive  dressings.  After 
dusting  with  boric  acid  the  entire  surface  may  be 
painted  with  a  solution  of  equal  parts  of  thiol  and 
w^ater  and  oiled  cotton  cloths  laid  on  over  the  bum. 
(Sj.) 

For  bums  of  the  first  degree,  the  following  pow^- 
der: 

zinc  Oxide,  5  parts. 

Magnesium  Carbonate,  lo  parts. 

Ichthyol,  I  to  2  parts. 

For  bums  of  the  second  degree : 

zinc  Oxide,  5  parts. 

Prepared  Chalk,  lo  parts. 

Starch,  lo  parts. 

Linseed  Oil,  lo  parts. 

Lime  Water,  i6  parts. 

Ichthyol,  I  to  3  parts. 

Both  the  powders  and  paste  are  renewed  daily. 
When  inflammation  is  intense  the  two  mav  be  em- 


BURNS   AND  SCALDS.  103 

ploj^ed  simultaneously,  the  burn  being  covered  with 
a  layer  of  the  powder,  and  the  paste  applied  over 
this"   (T.,  97.) 

Potass.  Nitcate  : — A  few  teaspoonfuls  in  a  basin  of 
water  gives  excellent  results  in  the  treatment  of 
bums  of  all  degrees.  It  acts  as  a  refrigerant;  as  it 
dissolves  it  lowers  the  temperature  of  the  water 
from  5°  to  9°.  If  a  burned  hand  or  foot  is  plunged 
in  such  a  solution  speedy  relief  will  be  obtained. 
When  the  water  becomes  warm  the  pain  returns, 
then  more  of  the  salt  must  be  added.  Baths  of  this 
solution  may  be  prolonged  three  or  four  days.  Com- 
presses ma^^  also  be  effectively  applied.  The  forma- 
tion of  blisters  is  in  a  measure  prevented,  and  cica- 
trization takes  place  rapidly.     (T.,  97.) 

Turpentine : — The  lininient  is  an  old  and  well 
known  remedy ;  it  may  be  applied  as  soon  as  possi- 
ble after  the  accident.  The  burned  surfaces  are 
dressed  with  cotton  and  gauze  saturated  with  the 
liniment  and  so  applied  as  to  exclude  the  air,  care 
being  observed  not  to  include  the  uninjured  skin. 
(Rd.)  The  injured  parts  may  be  brushed  with  tur- 
pentine, and  an  ointment  of  turpentine  and  basilicon 
applied.  This  constitutes  one  of  the  most  successful 
methods  of  treatment.     (F.) 

Creolin: — Gauze  soaked  in  a  2  per  cent,  solution. 

(Sj.) 

Eucalyptus  Oil: — ^gss— j— 5J  of  cosmoline.  (Al.)  Di- 
aphthorin  : — 1/2  tol  per  cent,  solution.  (Sm.)  Chloral 
Hydrate: — 5  per  cent,  solution,  antiseptic  and  seda- 
tive.    (Al.) 

Aristol: — Valuable;  quickly  relieves  pain.  (Sj.) 
This  substance  tends  to  form  a  thick  crust  over  an 
ulcerating  surface,  and  should  therefore  be  watched 


104  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

lest  secretions  and  discharges  be  retained.    It  is  bet- 
ter suited  to  superficial  lesions. 

Lime  "Water : — Combined  with  a   ointment  base, 
viz.: 

Lanolin,  i  part. 

Lard,  2  parts. 

Lime  Water,  3  parts. 

(M.  R.,  3,  10,  '96.) 

Continuous  ^Af^a^m  Bath: — This  is  advised  by 
Hebra  in  cases  of  extensive  bums.  He  emploj-ed  a 
bath-tub  six  feet  long  and  three  feet  broad,  in  the  in- 
terior of  w^hich  an  iron  frame  w^as  fitted,  and  trans- 
verse bands  of  \vebbing  were  attached  to  the  frame 
as  in  an  ordinarj-  bed.  The  frame  was  suspended  in 
the  both  by  cords  attached  to  each  end ;  it  w^as  pro- 
vided with  a  pillow  and  covered  with  a  blanket ;  at 
the  head  of  the  tub,  but  at  a  higher  level,  \vas  a  cop- 
per boiler  furnishing  water  at  any  desired  tempera- 
ture. This  was  connected  vv^ith  the  tub  by  a  pipe 
w^hich  entered  at  the  bottom ;  through  this  the  water 
flow^ed  continuously,  escaping  by  a  pipe  at  the  water 
level.  Thus  a  constant  flow  was  maintained.  The 
temperature  of  the  water  was  kept  at  90°  to  100°, 
and  entirely  changed  every  da3^  A  wooden  frame, 
over  which  a  blanket  w^as  spread,  v^'as  placed  over 
the  tub  while  the  patient  was  in  the  bath.  Hebra 
kept  his  patients  in  the  baths  without  interruption 
for  as  long  as  one  hundred  daj'^s.     (F.) 

When  suppuration  commences,  strict  cleanliness 
and  antisepsis  must  be  rigidly  enforced.  The  dress- 
ings must  be  changed  as  often  as  the  condition  of  the 
ulcerating  surfaces  and  the  rise  of  the  temperature 
indicate.    Little  balls  of  absorbent  cotton  soaked  in 


BURNS  AND  SCALDS.  105 

a  solution  of  Corrosive  Sublimate  1—3000  should  be 
used  for  cleansing.     (W.) 

Chloroform  : — In  severe  cases  the  administration  of 
this  anaesthetic  is  advised  at  the  time  of  dressing  not 
only  to  avoid  pain  but  to  lessen  shock.     (T.,  97.) 

In  the  stage  of  granulation  the  following: 

Balsam  Oil: — This  remedy,  introduced  by  the  late 
Dr.  W.  W.  Van  Arsdale  in  1893,  forms  an  excellent 
dressing  for  all  kinds  of  granulating  wounds,  includ- 
ing bums,  sloughing  wounds  and  incised  accumula- 
tion of  pus.  It  is  prepared  by  mixing  20  minims  of 
the  balsam  of  Peru  with  1  ounce  of  cold  pressed 
castor  oil.  For  ordinary  use  a  gauze  pad  may  be 
covered  with  the  oil,  which  can  be  distributed  by 
using  a  paint  brush  ;  sufficient  gauze  should  be  used 
to  absorb  all  the  expected  secretions,  especially  if  the 
dressing  is  to  remain  on  for  three  or  four  days.  The 
w^hole  dressing  must  be  covered  with  oiled  silk  or 
rubber  tissue  ample  enough  to  overlap  half  an  inch 
on  all  sides.  Layers  of  cotton  should  be  applied  to 
lend  support  and  the  w^hole  retained  in  place  by  a 
bandage.     (N.  Y.  M.  J.,  29,  7,  93.) 

Thymol:— In  the  strength  of  1-3000  has  been 
added  to  ointments,  such  as  those  of  boric  acid  or 
zinc  oxide.  It  is  claimed  under  its  influence  sloughs 
separate  sooner,  healthy  granulations  are  formed 
and  cicatrization  is  hastened.  The  scars  are  less  irri- 
table than  w^hen  carbolic  acid  is  used.     (Al.) 

Boric  Acid: — A  very  useful  dressing  employed  in 
various  strengths  both  in  solution  and  in  ointment. 
A  method  of  its  use  is  as  follows :  A  piece  of  oiled 
silk,  dipped  in  a  saturated  solution,  is  applied,  then  a 
piece  of  lint  of  a  somew^hat  larger  size  also  dipped  in 
the  solution  is  placed  over  the  silk  and  held  in  place 


106  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

by  a  bandage.  This  was  the  method  of  Lister.  A 
saturated  solution  is  especialW  recommended  for  the 
burns  of  the  actual  cautery  and  the  acid  nitrate  of 
mercury.     (B.) 

Bismuth  Subnitrate : — Mixed  with  glycerine  to  the 
consistency  of  thick  cream  and  spread  on  lint  then 
covered  with  oiled  silk  or  rubber.     (Al.) 

Salol: — In  the  proportion  of  3  parts  to  100  of 
lanolin,  allays  pain  and  inflammation.     (Al.) 

Salicylic  Acid: — 3j,  olive  oil  gviij.     (B.) 

Iodoform: — Forms  a  useful  dressing  in  the  propor- 
tion of  1  part  to  8  of  vaseline;  apply  on  lint  and 
cover  with  rubber  protective.     (W.) 

Dermatol: — EspecialW  valuable  in  lesions  attended 
w^ith  profuse  secretion  and  therefore  useful  in  bums. 
(Sm.) 

Copaiba: — Cotton  saturated  with  the  balsam  is  in- 
dicated w^hen  the  granulations  are  pale  and  flat. 
(Al.) 

Calendula: — The  cerate  thinned  with  olive  oil,  or 
the  foUow^ing : 

9;.    Tr.  Calendulae,  3j. 

Iviq.  Calcis, 

Ol.  Lini,  aa  gij- 

M.  (Rd.) 

Burns  of  a  Minor  Character. 

Cocaine: — A  4  per  cent,  ointment,  as  a  protective 
and  an  anodyne.  Being  insoluble  in  fatty  substances, 
the  cocaine  should  first  be  dissolved  in  oleic  acid  and 
afterwards  added  to  the  ointment  base  in  small 
quantities.     (Al.) 

Flexible  Collodion : — Greatly  benefits  bums  of  the 
first  degree  b^'  preventing  contact  with  the  air. 


BURSITIS.  107 

Sodium  Bicarbonate,  with  Cosmoline,  a  drachm 
to  the  ounce.  W^hite  of  Egg  mixed  with  Hamamelis 
Oil,  Liquid  Gutta  Percha,  Glycerite  of  Starch,  Rose 
Water  Ointment,  Molasses. 

Lotions  of  Tr.  Cantharides  1  part  to  10  of  water, 
or  Tr.  Urtica  Urens  1  part  to  4  of  water.     (C.) 

Bums  of  the  Eyelids. 

For  sHght  bums : — Finel^^  powdered  Bismuth,  Car- 
ron  Oil,  or  Cocaine  in  one  of  the  following: 

9(.    Cocain.  Hydrochlorat. ,  gr.  iij. 

Lanolini,  gr.  v. 

Vaselini, 

Aq.  Destill.,  aa  .^j. 

M. 

For  bums  of  the  second  degree : 

1^.    Cocain.  Hydrochlorat.,  gr.  xxiij. 

Salol.,  g.  xlv. 

Vaselini,  ^vj  gr.  xv. 

M. 
Sig.     Before  applying,  open  blister.     (T.,  97.) 


BURSITIS. 

Perfect  Rest  with  slight  counter-irritation,  with 
frequent  application  of  Tr.  Iodine  or  a  Blister,  will 
remove  the  swelling  in  most  instances.  If  the  cyst  is 
large  with  thin  walls  the  fluid  may  be  withdrawn  by 
Aspiration,  and  pressure  applied  with  a  rubber  band- 
age, but  when  the  walls  are  thick  and  there  is  evi- 
dence of  lymph  within  the  cavity,  as  denoted  by  a 
crackling  sound,  the  most  effective  measure  is  Inci- 
sion, turning  out  the  melon  seed  bodies  or  masses  of 


108  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

lymph,  then  inserting  a  drainage  tube  and  applying 
aseptic  dressings.  When  the  walls  are  excessively 
thickened  Excision  will  be  necessary.     (HI.) 


CANCER. 

The  following  are  intended  to  meet  the  require- 
ments of  the  practitioner  when  an  operation  is  re- 
fused, or  to  serve  as  palliatives  in  non-operative 
cases.  The  consensus  of  opinion  is  for  immediate 
removal  by  the  knife,  not  only  as  soon  as  diagnosis 
is  made,  but  also  in  all  doubtful  cases. 

Ulcerating  surfaces  should  first  be  made  as  clean  as 
the  condition  admits  by  the  use  of  antiseptic  solu- 
tions, such  as  Corrosive  Sublimate,  Potassium  Per- 
manganate or  Hydrogen  Peroxide ;  then  some  local 
remedy  for  the  relief  of  pain  and  the  destruction  of 
foetor  should  be  applied.  With  this  end  in  view  the 
following  are  recommended : 

Salicylic  Acid : — Injections  of  15  minims  to  1 
drachm  of  a  6  per  cent,  solution,  repeated  six  to 
thirteen  times,  have  been  used  w^ith  great  relief.  It 
is  claimed  that  this  is  the  best  treatment  for  non- 
operative  cases.     (Sj.) 

Carbolic  Acid: — A  mild  escharotic  applied  directly 
to  cancerous  sores  and  injected  beneath  the  affected 
part,  limits  and  retards  the  growth.  The  pure  acid 
is  used  for  application  to  the  ulcerating  surface  and 
a  5  per  cent,  solution  for  injection.    (B.) 

Iodoform : — Applied  to  the  surface  acts  as  an  anal- 
gesic and  deodorant.  It  may  be  combined  with 
Eucalyptus  as  follows : 


CANCER.  109 

|fc.    Iodoform  i,  5J- 

Ol.  Eucalypti,  5J- 

Vaselini, 
Paraffini,  aa  5j- 

M.  (Al). 

Lycoperdon : — Remarkable  virtue  is  claimed  for 
this  drug  as  a  haemostatic,  antiseptic  and  anodyne 
on  cancerous  ulcers.  The  powder  of  the  fungus  is 
employed.     (N.) 

Conium: — A  hemlock  poultice  or  lint  saturated 
with  the  succus  conii  are  useful  anodynes  on  ulcerat- 
ing surfaces.     (Wa.) 

Stramonium  Leaves: — The  following  effective  oint- 
ment is  used  at  the  Middlesex  Hospital,  London : 
Fresh  stramonium  leaves  ^2  lb.,  lard  2  lbs.;  mix  the 
leaves  (bruised)  with  the  lard,  heat  gently  and 
strain.     (Sm.) 

Calcium  Carbide : — The  cavities  of  the  cancer  are 
filled  with  the  remedy  and  ordinary  dressings  ap- 
plied. The  action  is  rapid,  produciiig  a  burning  sen- 
sation which  lasts  for  an  hour  or  two ;  at  the  end  ol 
that  time  pain,  foetor  and  discharge  have  disap- 
peared and  a  clot  formed  as  a  barrier  to  heemor- 
rhage.     (F.) 

Alcohol  Injections: — 30  parts  of  absolute  alcohol 
are  mixed  wdth  70  of  water;  injections  are  made 
around  the  tumor  and  infiltrated  glands  twice  a 
week.  The  quantity  injected  \vill  vary  with  the  size 
of  the  tumor,  sometimes  amounting  to  20  Pravaz 
syringefiils.  In  order  to  avoid  injecting  into  a  blood 
vessel  the  needle  is  inserted  deep  into  the  tissues, 
then  unfastened  from  the  syringe  and  left  in  place,  if 
blood  does  not  issue  the  injection  is  made,  if  it  does 
the  needle  is  removed  and  another  locality  punc- 


110  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

ttired.  Under  this  treatment  the  tumor  diminishes 
in  size  and  becomes  less  painful.  The  injections  may 
occasionally  cause  pain  and  intoxication.  Local  or 
general  anaesthesia  ma3'  be  employed.  (M.T.,  9,  97.) 

Alcohol  Compresses : — Have  a  good  effect  for  ar- 
resting the  bloody  oozing  often  observed.     (,A1.) 

Hydrastine  Hydrochlorate : — An  ointment  of  30 
grains  to  1  ounce  of  ointment  base  destro3^s  fcetor. 

Potass.  Chlorate : — In  a  fine  powder  is  used  for 
dusting  on  malignant  ulcerations.     (Sm.) 

Pyoktanin  Blue  : — Used  in  powders  or  solutions  of 
1  per  cent,  or  in  collodion  1-30,  the  latter  is  painless, 
easy  of  application  and  more  active.     (Sj.) 

Citric  Acid: — A  saturated  solution  subcutaneously 
introduced  at  any  point  near  the  periphery  of  the 
cancer  seems  to  possess  an  affinity  for  the  diseased 
structures ;  indurations  are  reduced  and  instant  re- 
lief is  said  to  be  obtained  from  the  smarting  and 
tension.     (Sj.)    . 

Atropine  : — Solutions  locally  for  pain  are  effective. 

(F.) 

Orthoform  : — The  powder  sprinkled  over  the  sur- 
face or  an  ointment  of  10  to  20  per  cent,  is  a  recent 
remedy  for  the  relief  of  pain.    See  Local  Anaesthesia. 

Escharotics. 

The  application  of  these  agents  is  limited  to  ulcer- 
ating cancers  and  to  the  removal  of  cancerous 
tumors  in  their  earlier  stages.  The  removal  of 
cancers  by  this  method  is  slow,  painful  and  less 
certain  to  expose  healthy  tissue  than  the  knife; 
nevertheless  escharotics  are  sometimes  used.  Before 
application,  if  the  skin  is  unbroken,  a  blister  or 
strong  ammonia  should  be  applied. 


CANCER.  Ill 

Zinc  Chloride: — One  of  the  best  mineral  caustics; 
has  the  advantage  of  not  poisoning  the  s^^stem  and 
limiting  its  action  to  the  point  of  contact.  The 
claims  for  its  superiority  over  the  knife  are  un- 
.founded.  Its  action  causes  intense  pain,  notwith- 
standing assertions  to  the  contrary.  Some  of  the 
methods  of  its  use  are  as  follows : 

Conquin' s  Paste,  a  well  known  preparation,  is 
made  in  various  w^ays.  The  U.  S.  Dispensatory  gives 
this  formula : 

^.    Zinc.  Chlorid.,  Jj. 

Pulv.  Amyl.  Exsiccat.,  Jij-iv. 

Aquae,  M.  xxx-^j. 
M. 

Zinc  oxide  or  anhydrous  sulphate  of  calcium  may 
be  substituted  for  the  amyl.     (Al.) 

Mayefs  Paste: — Zinc  chloride  8  parts,  zinc  oxide  1 
part,  flour  dried  at  212°  7  parts,  water  1  part ;  mix 
the  zinc  oxide  wdth  the  flour,  dissolve  the  zinc 
chloride  in  water  and  add  the  mixture  of  zinc  oxide 
and  flour;  rub  the  paste  in  a  mortar  ten  minutes. 
(N.) 

Method  of  Maisonneuve : — '^Cauterization  en 
Flecbes.^^  This  is  applied  as  follows :  The  patient  is 
narcotized,  and  if  it  is  thought  necessary  a  knife  is 
passed  deep  into  the  growth ;  arrows  of  the  caustic 
are  inserted  at  several  points  w^hich  are  cat  close  and 
left  in.  Hypodermics  of  morphine  will  to  a  certain 
extent  relieve  the  pain,  which  is  very  severe  for  some 
hours.  The  skin  w^ill  turn  a  dead  white.  A  poultice 
is  now  applied  and  in  a  few  days  the  mass,  it  is  said, 
"shells  out  like  a  billiard  ball,"  exposing  a  surface 
w^hich,  if  healthy,  w^ill  cicatrize,  but  if  not,  the  treat- 
ment must  be  repeated.     (HI.) 


112  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Potassa  Cum  Creta: — By  mixing  Avith  alcohol  this 
substance  is  made  into  a  paste ;  it  may  be  rendered 
nearly  painless  b^^  the  addition  of  morphine  and  is 
applied  as  a  plaster ;  at  the  end  of  fifteen  minutes  the 
skin  is  carbonized  and  if  retained  a  slough  will  be 
formed  as  thick  as  the  plaster.  A  clear  surface  will 
be  left  which  heals  rapidly.     (Al.) 

Sulphuric  Acid: — This  agent  is  regarded  as  supe- 
rior to  other  escharotics  for  the  destruction  of  malig- 
nant growths.  Michel's  Paste,  a  form  of  its  applica- 
tion, is  prepared  thus:  1  part  by  w^eight  of  some 
indifferent  excipient  and  3  parts  of  fuming  sulphuric 
acid  are  mixed  on  a  glass  slab  forming  a  paste, 
which  is  applied  in  the  following  manner :  If  the  sur- 
face is  unbroken  it  should  first  be  blistered  and  the 
epidermis  removed,  after  which  cocaine,  not  exceed- 
ing one  and  a  half  grains  to  the  ounce,  is  applied,  at 
the  same  time  a  hA'podermic  of  morphine  is  adminis- 
tered. After  the  cocaine  has  taken  effect,  the  paste  is 
applied  entirely  over  the  tumor  to  the  depth  of  about 
half  an  inch.  If  these  precautions  are  taken  it  is 
claimed  that  no  pain  is  experienced.  After  the  tumor 
is  destroyed  the  cavity  is  v^^ashed  out,  filled  with 
asbestos  and  covered  with  zinc  ointment.  It  usualh-- 
takes  ten  to  t\velve  days  for  the  eschar  to  separate ; 
during  this  time  the  w^ound  should  be  irrigated  daily. 
The  patient  should  be  kept  on  the  level,  otherwise 
the  acid  will  gravitate  to  one  side  and  a  portion  of 
the  tumor  will  escape  its  action.  The  surrounding 
skin  should  be  protected  b3'  collodion,  and  all  oozing 
of  any  fluid  carefulh'  mopped  up.     (Al.) 

Arsenious  Acid: — This  agent  is  better  adapted  to 
epitheliomatous  growths.    Its  application  is  painful 


CANCER.  113 

and  not  v^^ithout  danger.    The  following  are  some  of 
its  preparations  as  an  escharotic : 

"  Poudre  Caustique  de  Frere  Cosme  ou  de  Rousse- 
lot :" 


•.    Acid.  Arsenosi, 

gr.  X. 

Hydrarg.  Sulphid.  Nig., 

3ij. 

Pulv.  Carbonis  Animalis, 

[. 

gr.  X. 

The  powder  is  mixed  with  mucilage  at  the  time  of 
applying.     (Al.) 

"  Februre's  Remedy ;" 

9^.    Acid.  Arsenosi,  gr.  x. 

Aq.  Destill.,  Oj. 
adde 

Ext.  Conii,  J^j. 

Liq.  Plumbi  Subacetat.,  J^iij. 

Tr.  Opii,  3j. 
M. 

With  this  the  cancers  is  washed  every  morning. 
(U.S.) 
"Jusetmond's  Arsenical  Powder  .•" 

^.    Antimonii  Sulphuret.,       •  gr.  xvj. 

Acid.  Arsenosi,  gr.  j. 

M. 

Melt  in  a  crucible ;  when  cold,  reduce  the  mass  to 
powder  and  add  5  parts  of  extract  of  opium. 
''Manec's  Paste:'' 


1^.    Acid.  Arsenosi, 

gr.  XV. 

Hydrarg.  Sulphid.  Nig., 

gr.  Ixxv. 

Spong.  Ustae, 

gr.  XXXV. 

M. 

This  is  made  into  a  thick  paste  \^ith  a  few  drops  of 
water.     (Al.)  . 

9 


114  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

Method  of  Czerny  and  Trunecek:  Arsenious  acid  1 
part  in  75  each  of  ethylic  alcohol  and  distilled  ^vater, 
paint  the  growth.  In  twenty-four  hours  it  will  be 
covered  with  an  eschar,  which  after  daih^  repetition 
of  the  painting  Avill  come  off.     (T.,  98.) 

Sodium  Ethylate  :  —  First  cleanse  the  part  with 
pyrozone  and  6xy  thoroughh",  then  anasthetize  with 
cocaine  10  per  cent,  solution,  and  apply  the  remedy 
full  strength  by  means  of  a  glass  rod.  This  strength 
is  obtained  by  alloAA'ing  the  cr\'stals  to  deliquesce. 
The  following  powder  is  then  dusted  thickh'  over 
the  diseased  surface : 

9^.    Acetanilidi,  5j- 

Aristoli,  5^j-i 

Acid.  Bond,  3J- 

M. 

Vaseline  is  then  spread  on  sheet-wadding  of  suffi- 
cient size  to  cover  the  whole  surface,  over  this  ab- 
sorbent cotton,  and  bandage.  The  patient  is  seen 
everA"  second  dary,  but  onh^  the  diseased  points  are 
touched  afterwards.  Considerable  oedema  follows 
the  first  application,  but  it  soon  disappears.  The 
ethylate  is  very  painful  aiid  cocaine  does  not  always 
relieve.  It  should  be  kept  in  small  corked  bottles, 
care  being  taken  that  it  does  not  touch  the  cork. 
(T.,  98.) 

Alveloz  : — This  drug  has  caustic  action  similar  to 
zinc  chloride  and  has  been  used  with  asserted  suc- 
ces.  Its  application  is  comparatively  painless.  The 
juice  of  the  plant  is  preserved  for  transportation  by 
the  addition  of  salic3dic  acid.     (F.) 


CANCER  OF  LARYNX.  115 

CANCER  OF  LARYNX. 

Sodium  of  Formate  : — Solutions  of  5  to  20  grains 
to  the  ounce  of  water  or  glycerine  as  a  spray  or  2 
parts  Avith  8  of  starch  as  an  insufflating  powder 
blown  only  on  the  ulcerated  surface,  have  proved 
serviceable  applications.     (F.) 

Carbolic  Acid  : — Add  20  to  40  drops  to  a  pint  of 
water  wnth  a  small  amount  of  glycerine,  heat  to 
140°  and  inhale  the  vapor.     (Al.) 

The  following  are  for  use  with  the  atomizer : 

Hydrogen  Peroxide. 

Pyoktanin,  V2  per  cent,  solution. 

Potass.  Permang.,  2  per  cent,  solution. 

Carbolized  Alkaline  Sprays  as  mentioned  for  Ca- 
tarrh and  Rhinitis. 

Morphine,  2  per  cent,  solution. 

Cocaine,  5  to  10  per  cent,  solution;  more  effective 
than  morphine. 

Thuja,  local  applications  have  relieved. 

CANCER  OF  THE  RECTUM. 

As  in  cancer  of  other  localities,  any  treatment 
other  than  extirpation  is  simply  palliative.  Seda- 
tives of  many  kinds  may  be  administered  with 
benefit,  and  \vhen  one  ceases  to  be  of  service  another 
may  be  tried. 

Opium: — In  some  form  this  is  one  of  the  best  reme- 
dies ;  in  suppositories  made  with  3  parts  of  glycerine 
to  1  of  gelatine,  it  acts  less  like  a  foreign  body  and 
melts  more  readily.  Battley's  sedative  or  black 
drops  in  starch  injections  and  hypodermics  of  mor- 
phine are  effective.  (Gt.)  In  administering  opium 
or  morphine  the  greatest  care  should  be  taken  not  to 


116  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

give  any  more  than  absolutely  necessary  as  it  must 
be  continued  for  months,  and  the  mental  state  some- 
times caused  by  it  is  most  distressing. 

Py oktanin : — The  following  suppository  is  advised : 

^.    Pyoktanini,  gr.  j. 

Pulv.  Opii,  gr,  xV- 

Ol.  Theobromse,  q.  s. 

M.  (T.,  96.) 

Arsenite  of  Copper: — A  paste  made  by  mixing  the 
remedy  with  mucilage  may  be  applied  to  protruding 
cancerous  masses,  an  extremely  rare  condition.  (Gt.) 

CANCER  OF  THE  UTERUS. 

Curettage  and  the  Actual  Cautery: — The  applica- 
tion of  these  measures  followed  by  antiseptic  dress- 
ings is  an  old  and  effective  method  which  has  stood 
the  test  of  time.  The  patient  is  anaesthetized  and 
placed  in  the  dorsal  position,  all  readily  removable 
tissues  are  gouged  out  with  a  sharp  curette  under 
continuous  irrigation.  The  haemorrhage  is  stopped 
by  packing  the  cavity  v^rith  iodoform  gauze,  leaving 
it  in  place  for  a  short  time,  then  removing.  The  in- 
terior of  the  excavation  is  now  cauterized  with  the 
round  ball  of  the  Paquelin  cautery  at  a  red  heat, 
then  irrigated  w^ith  a  solution  of  boric  acid  1-20. 
Tampons  saturated  in  a  50  per  cent,  solution  of  zinc 
chloride  may  also  be  used  after  curettage,  as  de- 
scribed under  that  remedy.     (K,  C.) 

Alcohol: — When  infiltration  of  the  surrounding  tis- 
sues is  feared  parenchymatous  injections  of  absolute 
alcohol  may  be  employed,  using  80  minims,  the  injec- 
tions being  made  at  several  points,  but  not  punctur- 
ing very  deeply.  Usually  after  ten  to  fifteen  injec- 
tions the  discharge  lessens  or  disappears  and  the 


CANCER  OF  THE  UTERUS.  117 

patient  improves.  If  the  growth  is  too  near  the 
peritoneum  to  permit  of  this  procedure,  alcohol  in 
the  form  of  baths  to  the  part  may  be  administered 
by  means  of  a  tubular  speculum.     (T.,  97.) 

Ferric  Chloride: — For  haemorrhage  saturate  two 
or  three  pieces  of  lint  with  the  chloride  and  place 
them  in  contact  with  the  cervix,  then  tampon  with 
dry  cotton.  To  avoid  excoriation  of  the  vaginal 
mucous  membrane,  which  occurs  unless  the  chloride 
is  very  much  diluted,  add  carbonate  of  soda  in  the 
proportion  of  4  grains  to  the  ounce  of  the  chloride. 
(Al.) 

Steam : — Vaporization  of  the  uterus  for  cancer  of 
the  fundus  has  been  employed  for  its  heemostatic, 
anaesthetic  and  caustic  effects.  The  steam  is  intro- 
duced by  means  of  a  canula  attached  to  a  rubber 
tube  and  applied  for  one  and  a  half  minutes ;  it  is 
followed  immediately  by  a  dark  colored  fluid.  (F.) 
Compare  Vaporization,  under  Chronic  Endometritis. 

Chromic  Acid : — This  is  used  pure  and  in  dilutions. 
An  effective  method,  which  is  said  to  be  of  great 
benefit,  consists  in  first  irrigating  the  uterus  and 
vagina  wnth  a  hot  salt  solution  and  then  applying 
the  acid  in  the  strength  of  1  part  to  3  parts  of 
water.  Care  should  be  observed  not  to  permit  any 
of  the  caustic  to  come  in  contact  with  the  healthy 
tissue,  w^hich  must  be  protected  by  a  saturated  solu- 
tion of  bicarbonate  of  soda.  Tampon  w^ith  iodoform 
gauze  after  the  application.     (F.) 

Ferripyrin: — Being  astringent  as  well  as  anaes- 
thetic, is  applicable  for  the  control  of  haemorrhage 
and  discharge.  It  may  be  applied  directly  to  the  dis- 
eased surface  or  mixed  with  charcoal  placed  in  little 
bags  and  introduced  into  the  vagina.     (T.,  97.) 


118  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Pyoktanin  Blue  :  — As  a  dusting  powder  with 
gauze  packing  of  the  same,  has  improved  the  general 
condition.  (Sj.)  Solutions  of  1-300  are  injected  in 
the  infiltrated  tissue,  a  few  drops  at  each  point, 
using  about  thirty  in  all,  at  intervals  of  one  or  two 
days;  curettage  should  precede  the  injections  and 
the  dry  pov^^der  be  used  in  the  uterus.  This  measure 
will  prolong  life.  (K.  C.)  A  medicated  craj^on  for 
introduction  into  the  cervical  canal  may  be  made 
as  follows : 

9;.    Pyoktanini, 

Acid.  Tannici,  aa  gr.  iv. 

Piilv.  Opii,  gr.  j. 

Ol.  Olivae,  gtt.  xv. 

Ol.  Theobromae,  53- 

M. 
Sig — Retain  crayon  with  tampons.     (T.,  98.) 

Terebene  : — Tampons  soaked  in  a  solution  of  1—16 
of  olive  oil  or  used  pure  act  well  as  antiseptics  and 
deodorants. 

Pepsin  : — Good  results  have  followed  its  applica- 
tion to  cancer  of  the  cervix ;  much  of  the  neoplastic 
tissue  may  be  destroyed  this  w^ay.     (Sm.) 

Salicylic  Acid  : — Parenchymatous  injection  of  a  6 
per  cent,  solution  in  alcohol  has  been  employed  with 
satisfactory  results.  (Sj.)  A  tampon  thoroughly 
impregnated  ^^nth.  the  drug  may  be  inserted  twice  a 
day  to  correct  foetor,  in  conjunction  with  vaginal 
douches  of  a  3  per  cent,  solution  of  creolin.     (Al.) 

Zinc  Chloride  : — This  remed\^  rna^'  be  employed 
after  curettage  and  the  actual  cautery.  Czerny  used 
4  parts  of  the  chloride  with  1  of  zinc  oxide  and  3  of 
flour  enclosed  in  gauze  secured  with  a  tampon  by  a 
string  attached  for  easy  removal.    This  was  allowed 


CANCER  OF  THE  UTERUS.  119 

to  remain  about  six  hours,  or  less  if  there  seemed 
any  risk  to  the  vesical  or  rectal  septum.  On  its  re- 
moval, iodoform  gauze  was  inserted.     (N.) 

Another  method  after  curettage  and  the  actual 
cautery  consists  in  packing  the  crater  of  the  cancer 
with  pledgets  of  absorbent  cotton  the  size  of  a  wal- 
nut, which  has  been  soaked  in  a  50  per  cent,  solution 
of  the  chloride  and  applying  a  non-absorbent  cotton 
tampon  over  these.  The  zinc  chloride  produces  a 
still  further  separation  of  the  cancerous  tissues,  and 
in  about  a  w^eek  or  ten  days  the  slough  may  be  re- 
moved. In  case  there  is  haemorrhage  after  the  sep- 
'  aration  of  the  slough  the  cavity  may  be  packed  w4th 
iodoform  gauze.  Solutions  of  bicarbonate  of  soda 
should  be  employed  to  neutralize  any  of  the  chloride 
which  ma^^  come  in  contact  with  the  vagina.  (K.  C.) 

Bismuth  Subnitrate,  mixed  w^ith  Aristol  or  Iodo- 
form, maj'  be  dusted  on  the  interior  of  the  cavity 
^vhen  curettage  is  not  practicable  on  account  of  the 
disease  being  too  far  advanced.  (K.  C.) 

Calcium  Carbide: — A  piece  the  size  of  a  small  w^al- 
nut  is  placed  in  contact  with  the  diseased  part  and 
the  vagina  quickly  filled  with  iodoform  gauze,  which 
is  removed  in  a  few^  days  and  an  antiseptic  douche 
administered.  (T.,  97.)  This  remedy  has  been  used 
in  France  with  favorable  results.  The  calcium  carb- 
ide decomposes  into  calcium  oxide  and  acetylene 
gas;  at  the  end  of  several  days  the  oxide  is  easily 
removed  by  an  antiseptic  douche  (corrosive  subli- 
mate). The  diseased  part  becomes  grayish  and 
smooth,  and  the  pain  and  hfemorrhage  are  sup- 
pressed.    (F.) 

Salol  Gauze: — May  be  used  with  good  effect  for 
packing  after  the  curette  and  cautery.    (T.,  98.) 


120  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Sodium  Chlorate: — This  remedy'  is  advised  inter- 
nally and  locally  as  a  palliative.    Locally : 

9;.  Sodii  Chloratis, 

Bismuthi  Subnitratis,  aa,  5iiss. 

lodoformi,  5J- 

M. 
Sig.     A  small  quantity  is  applied  by  a  tampon  to  the  cervix. 

Strips  of  sterilized  gauze  six  inches  long  and  two 
wade  impregnated  with  1  part  of  iodoform,  20  parts 
of  sodium  chlorate  and  20  parts  of  glycerine  may 
also  be  used.  If  symptoms  of  iodoform  poisoning 
appear,  tampons  of  salolized  cotton  saturated  in  a 
20  per  cent,  solution  of  chlorate  of  sodium  should  be 
substituted.  Finalh-  a  vaginal  douche  of  a  quart  of 
sterilized  w^ater  holding  in  solution  150  grains  of 
chlorate  of  sodium  should  be  administered  dailv. 
(T.,98.) 

Nitric  Acid: — Recommended  as  an  effective  caus- 
tic ;  the  acid  is  applied  to  the  whole  diseased  surface 
and  a  pad  saturated  with  gh^cerine  placed  over  it. 
This  treatment  produces  a  slight  slough  and  de- 
stroys many  of  the  sources  of  haemorrhage.  It  maj-- 
be  used  ever\'  two  or  three  months.     (Al.) 

Hydrastis  and  Sanguinaria: — For  epitheliomatous 
ulcerations  of  the  cervix,  equal  parts  of  each  in  pow^- 
der  have  been  emploj^ed  with  good  effect. 

Orthoform: — For  the  relief  of  pain  the  following: 

1^.    Orthoformi,  gr.  xv. 

Acid.  Arsenosi,  gr.  iss. 

Alcoholis,  M.cxx. 

Aquae,  M.cxx. 
M. 

Sig. — A  tampon  of  absorbent  cotton  is  saturated  with  this  solu- 
tion and  applied perza^itiam.  (R.  M.,  12,  5,  98.) 


CANCER  OF  THE  UTERUS.  121 

For  the  Control  of  Hsemorrhage :  Tr.  Iodine 
(Churchill's),  Persulphate  of  Iron  in  glycerine  on 
pledgets  of  cotton,  strong  solutions  of  Alum  and 
Packing  the  Vagina,  the  latter  should  be  employed 
when  the  haemorrhage  is  alarming;  the  tampon 
should  be  made  of  antiseptic  cotton  with  a  string 
attached  to  each  to  facilitate  removal.     (Cp.) 

Tampons  heavily  loaded  w^ith  equal  parts  of  Ben- 
zoin, Iodoform  and  Magnesia  may  be  used  in  place 
of  injections.     (T.,  98.) 

Hot  W^ater  Douches: — These  are  valuable  for  the 
relief  of  pain  and  the  control  of  hsemorrhage,  but 
especially  for  cleansing. 

Antiseptic  Douches: 

Jfc.    Acid.  Carbolici,  gr.  viij. 

Glycerini,  3  viij. 

Ess.  Thymi,  3iij- 

M. 
Sig. — A  teaspoonful  to  i  or  2  quarts  of  water. 

^.    Acid.  Salicylici,  gr.  xv. 

Ess.  Geran.  Ros.,  3igr.  xv. 

Alcohol,  90  per  cent.,  ^vj. 

M. 

Sig. — A  tablespoonful  to  a  pint  of  water.  (T.,  98. ) 

The  following  are  for  vaginal  injection  in  the  pro- 
portion of  the  amount  mentioned  to  one  pint  of 
■water : 

Acidum  Carbolicum,  3ss— j. 

Acidum  Gallicum,  gr.  xx— 5J. 

Acidum  Tannicum,  gr.  xx-^j. 

Acidum  Salicylicum,  3J. 

Alumin,  5J-iv. 

Aqua  Chlorinii,  giv, 

Creosotum,  Mx-^ss. 


122  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Cupri  Sulphas,  gr.  x— xxx. 

Ferri  Sulphas,  gr.  xxx. 

Kino,  §j. 

Krameria,  ^ss. 

Lfiquor  Ferri  Sulphatis,  gij— iv. 

Liquor  Plumbi  Subacetatis,  .5J— ij. 

Liquor  Sodae  Chlorinatae,  5j. 

Plumbi  Acetas,  gr.  x— xx. 

Potassii  Chloras,  ^j. 

Potassii  Permanganas,  gr.  xx. 

Quercus  Alba,  gss. 

Sodii  Hyposulphis,  .?j— ij. 

Tr.  Ferri  Chloridi,  3ss-j. 

Zinci  Chloridum,  gr.  v-vij. 

Zinci  Sulphas,  .^j— ij.     (Dn.) 


CANCRUM  ORIS. 

Cauterization:  —  This  is  the  first  indication  and 
should  be  immediately  applied  with  care  and  thor- 
oughness to  every  portion  of  the  diseased  area.  The 
Paquelin  or  the  Electro-cautery  are  the  best 
methods,  as  they  can  be  more  easily  controlled. 
The  resulting  eschar  should  be  dressed  with  w^arm 
boric  acid  solutions  until  it  separates;  then  with 
astringent  lotions.     (Mus.) 

Other  energetic  caustics  are  Nitric  Acid,  Hydro- 
chloric Acid,  Bromine,  Vienna  Paste  and  Zinc 
Chloride.  The  after  treatment  should  include  direct 
applications  of  Iodoform,  Pyoktanin  Blue,  Ichthyol, 
and  Carbolic  Acid.     (Gn.) 

Pyoktanin    Blue:  —  Subcutaneous    injection    of    a 


CARBUNCLE.  123 

saturated    solution    promises    much,    according   to 
Goodno. 

Potass.  Permang.,  1-100;  Formalin,  1—15  or  30; 
Tr.  Iodine,  Fid.  Ext.  Eucalyptus,  pure  or  with  equal 
parts  of  glycerine,  are  recommended  for  use  after  the 
removal  of  the  slough,     (Jac.) 


CARBUNCLE. 

Compare  Abscess. 

Carbolic  Acid: — This  effective  remedy  is  employed 
in  several  ways.  A  successful  method  of  its  applica- 
tion is  as  follows  (Dr.  M.  O.Terry):  First,  apply  sev- 
eral laj^ers  of  collodion  over  the  carbuncle  extending 
beyond  the  periphery  of  inflammation,  but  leaving 
an  uncovered  area  in  the  centre  of  about  one-quarter 
of  an  inch.  Second,  make  a  small  crucial  opening. 
Third  inject  the  following:  Crystals  of  carbolic  acid, 
20  grains ;  gljxerine  and  w^ater,  each  2  drachms. 
The  injections  should  be  made  with  a  hypodermic 
syringe  to  which  a  lachrymal  canula  is  attached ; 
push  the  canula  well  toward  the  periphery,  injecting 
a  few  drops  in  several  directions.  Repeat  daily  if 
necessary.  As  a  rule,  not  more  than  five  injections 
will  be  required.  Simple  dressing  of  vaseline  and  cal- 
endula and  iodoform  may  then  be  applied.  (Hel.) 
Injections  of  5  to  10  minims  of  a  2  per  cent,  solution 
(F.),  or  5  drops  of  the  pure  acid  at  each  point  of  the 
carbuncle  are  said  to  arrest  the  development.  (T., 
97.) 

Non-incision  Treatment: — The  foUow^ing  formula 


gr.  V- 

•X, 

sHj- 

aa 

124         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

is  highly  praised  by  Dr.  L.  D.  Bulkley  for  carbuncles 
as  well  as  boils : 

9:.    Acid.  Carbolici, 

Fid.  Ext.  Ergotae, 

Pulv.  Amyli, 

Zinc.  Oxidi, 

Ung.  Aq.  Rosae, 
M. 

Spread  thickly  on  lint  and  apply.  It  is  claimed 
that  incision  has  seldom  been  necessary  with  this 
treatment,  and  that  better  results  are  obtained  than 
with  the  knife,  except  in  more  malignant  cases  with 
gangrene.  Bulkley  adds :  **  I  have  applied  this  treat- 
ment to  some  large  and  formidable  carbuncles,  and 
have  always  found  that  the  pus  would  find  exit  read- 
ily enough  and  healing  progress  satisfactorily  under 
this  dressing.  On  some  occasions  febrile  and  other 
symptoms  have  seemed  to  call  for  more  active  inter- 
ference w^ith  the  knife ;  but  although  urged  to  do  it, 
I  have  adhered  to  the  plan  of  treatment  vsrithout  in- 
cision, and  have  obtained  results  which  have  war- 
ranted its  continued  employment.  I  am  prepared  to 
admit,  however,  that  possibly  from  neglect  or  other 
causes  a  very  large  suppurating  carbunculous  area 
might  be  formed,  v^hich  would  demand  active  sur- 
gical procedure.  I  may  add  that  Sir  James  Paget 
stronglv  discountenances  the  practice  of  incision," 
(Bk.) 

Excision  and  Erasion :  —  This  procedure  is  indi- 
cated v^hen  it  is  not  possible  to  isolate  the  disease 
from  the  surrounding  tissues.  Remove  as  much  as 
possible  w^ith  the  knife,  scissors  and  Volkmann's 
spoon,  and  in  cases  where  a  clean  surface  is  impossi- 
ble swab  the  raw^  surface  with  a  solution  of  chloride 


CARBUNCLE.  125 

of  zinc,  gr.  xl-|j.  A  large  circular  wound  will  be  left, 
which  is  painted  with  carbolic  acid,  alcohol,  methyl 
violet,  each  1  part,  water  10  parts,  then  dust  with 
iodoform  and  pack  with  iodoform  gauze.  The  in- 
cision should  be  made  deep  around  the  circumference, 
at  least  half  an  inch  from  the  infected  part.  Haem- 
orrhage may  be  guarded  against  by  pressure  forceps 
in  the  hands  of  an  assistant.  After  excision  great 
care  must  be  taken  not  to  infect  the  wound.  (T.,  97.) 

Crucial  Incision  with  Carbolic  Acid  Injections: — 
When  incision  is  impracticable  multiple  crucial  inci- 
sions may  be  made  across  the  surface  of  the  carbun- 
cle, then  inject  hypodermicall3^  carbolic  acid  1—10. 
The  injections  should  be  made  carefully,  so  as  to 
diffuse  the  solution  throughout  the  base  of  the  in- 
fected part,  and  the  puncture  must  be  deep,  drawing 
the  needle  slowly  while  injecting  a  few  drops.  The 
incision  must  be  carefully  mopped  out  with  the  acid  ; 
then  compresses  "wet  with  a  solution  of  bichloride,  1- 
1000,  applied,  and  an  ice  bag  over  the  dressing.  The 
injections  are  to  be  repeated  every  six  hours  until  the 
disease  is  under  control.     (A.) 

Crocker  recommended  Glycerine  of  Belladonna 
spread  on  lint,  followed  later  by  Ung.  Resinae  until 
suppuration  occurred;  then  the  removal  of  the 
sloughs  with  the  scissors  when  they  are  slow^  in 
separating,  or  when  septic  absorption  is  threatened. 
The  wound  is  dressed  antiseptically.     (Hd.) 

Iodine  Liniment : — Painted  freely  on  the  part,  fol- 
lowed by  the  application  of  a  thick  pad  kept  in  place 
by  an  elastic  bandage,  is  recommended.  When  the 
carbuncle  is  situated  on  the  limb  it  is  claimed  that 
relief  is  very  marked,  and  that  the  patient  can  be 
permitted  to  go  about.     (T.,  97.) 


126  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Antiseptic  irrigating  solutions.    See  also  Abscess. 

Hydrarg.  Bichlorid.,  1-2000  or  1-3000. 

Potass.  Permang.,  gr.  x— 5j. 

Hydrogen  Peroxide. 

Dusting  powrders  are  indicated  during  the  process 
of  healing.  Acetanilid,  Airol,  Dermatol,  Iodoform, 
Pyoktanin  Blue,  1  to  2  per  cent.,  Resorcin,  Sano- 
form,  Xeroform,  etc. 


CARIES  AND  NECROSIS  OF  BONE. 

Iodoform  : — 1  part  to  10  of  glycerine  was  used  by 
Billroth  in  tuberculous  caries,  viz.:  The  abscess  was 
first  opened,  the  bone  scraped,  the  cavity  thoroughly 
cleansed  and  firmly  rubbed  with  a  pledget  of  iodo- 
form gauze.  The  wound  v^as  then  stitched  up,  leav- 
ing an  opening  in  which  the  iodoform  emulsion  was 
poured.  Recovery  by  first  intention  may  be  ex- 
pected. Usually  a  second  dressing  will  be  required. 
(Sm.) 

Myrrh: — When  the  discharge  is  very  offensive  this 
w^ill  form  a  useful  stimulating  dressing.  It  may  be 
combined  with  potassium  chlorate  in  the  proportion 
of  2  drachms  of  each  to  4  ounces  of  distilled  water. 
(Al.) 

Turpentine: — Diluted  with  olive  or  almond  oil  is 
of  especial  value  in  caries  of  the  temporal  bone.  Ap- 
plications may  be  made  every  three  or  four  days. 
(Al.) 

Potass.  Permang.: — Gr.  iij-x-^,  applied  with  a 
brush  or  compress.     (F.) 

Liqueur  de  Villate : 


CARIES  AND   NECROSIS   OF   BONE.  127 


9^.    Cupri  Sulphatis, 

Zinci  Sulphatis, 

aa  gr.  xv 

Liq.  Pliimbi  Subacetatis, 

3.SS. 

Acid.  Acetici  Diluti, 
M. 

3  iiJsS' 

A  small  quantit}^  is  injected  into  the  sinus.  It  is 
claimed  that  only  the  outer  portion  of  the  bone  be- 
comes decalcified. 

Acidulated  Pepsin:  —  An  artificial  digestive  fluid 
has  been  used  for  the  removal  of  dead  bone  from  sup- 
purating tracts.  It  is  employed  as  follows :  An  open- 
ing is  made  in  the  soft  parts  by  the  most  direct  route 
to  the  diseased  bone,  then,  if  possible,  the  sinuses 
are  made  to  connect  and  are  kept  patulous  by  plugs 
of  antiseptic  gauze.  A  3  per  cent,  solution  of  hydro- 
chloric acid  is  then  injected.  This  may  be  done  every 
two  hours  if  the  patient  is  confined  to  bed ;  if  not, 
once  daily.  After  decalcification  of  the  exposed  bone 
flush  the  sinus  with  hydrogen  peroxide,  or  bichloride 
of  mercury  1—2000,  and  inject  the  following: 

^.    Pepsin.,  3ss. 

Acid.  Hydrochloric,  M.xvj. 

Aq.  Destill.,  ^iv. 
M. 

Digestion  of  the  bone  and  tissue  detritus  will  take 
place  in  about  two  hours.  The  procedure  may  be 
repeated  in  two  days.     (Al.) 

Lactic  Acid : — The  concentrated  acid  has  been  used 
on-  lint  or  absorbent  cotton  covered  with  an  imper- 
meable tissue  and  bandaged  in  cases  of  fungous 
caries.  The  healthy  skin  should  be  protected  with 
adhesive  plaster;  after  twelve  hours  remove  the 
caustic,  cleanse  the  part  and  apply  moist  dressings 
for  twelve  to  twenty -fours.  The  acid  may  be  re- 
peated as  often  as  necessary.     (F.) 


128         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Nitric  Acid  : — As  a  caustic  to  hasten  suppuration, 
especiallv  when  there  is  sloughing  of  the  soft  parts. 
(N.) 

Sulphuric  Acid: — A  swab  on  an  aluminum  appli- 
cator ma^'  be  applied  to  the  necrosed  bone,  especially 
when  exfoliation  is  slow.  The  effect  is  solvent  and 
cauterant,  and  tends  to  the  removal  of  diseased  part. 

(F.) 

Hydrochloric  Acid: — The  dilute  acid  has  been  used 
as  an  injection  in  tuberculous  caries. 

The  pure  acid  has  also  been  employed,  a  few  drops 
being  applied  directlj^  by  means  of  a  glass  pipette  to 
the  diseased  bone  and  allowed  to  remain  on  for  one 
minute;  afterwards  irrigate  with  a  saturated  solu- 
tion of  carbonate  of  soda  and  applj^  myrrh  dress- 
ing.    (F.) 

Operation : — When  posssible,  is  generally  preferred 
to  any  other  method. 


CARIES  OF  TEETH. 
See  Toothache. 

Gum  Mastiche  : — Often  employed  as  a  temporary 
filling,  in  solution  with  ether,  1  part  to  4;  a  small 
piece  of  cotton  being  saturated  with  the  solution  is 
pressed  downa  into  the  cavity,  which  should  be  pre- 
viously cleansed.     (Al.) 

Myrrh : — Serviceable  as  a  mouth  wash,  viz.: 

¥fc.    Potass.  Chloral.,  3ij. 

Tr.  Myrrh.,  3ij. 

Aq.  Destill.,  q.  s.  ad  ^vj. 
M.  (Al.) 


CELLULITIS.  129 

Hydronaphthol : — As  a  mouth  wash  and  prevent- 
ive of  dental  caries,  viz : 

9;.    Hydronaphthol.,  gr.  xvj. 

Alcohol.,  3j- 

Aq.  Destill.,  5j. 

M. 

Sig. — A  tablespoonful  to  half  a  pint  of  water.     Use  freely. 

It  should  be  made  in  small  quantities,  since  the 
preparation  is  unstable.     (Al.) 

Creosote  Collodion : — Recommended  as  an  appli- 
cation to  the  cavities  of  carious  teeth.     (F.) 

Ethyl  Chloride : — This  agent  may  be  used  as  a 
dental  anaesthetic,  viz.:  First,  thoroughly  dry  the 
gum  and  cover  it  with  vaseline,  and  protect  the 
neighboring  parts  with  wool.  The  patient  should  be 
instructed  to  breathe  through  the  nose.  The  chloride 
may  be  applied  to  both  sides  of  the  tooth,  freezing 
the  parts.  In  extraction  it  is  not  necessary  to  spray 
on  both  sides  of  the  tooth,  the  jet  may  be  thrown 
near  the  entrance  of  the  dental  nerve  in  front  of  the 
ear  for  the  upper,  and  behind  the  ramus  of  the  in- 
ferior maxilla  for  the  lower  ja^v.  Anagsthesia  of  the 
whole  jaw^,  it  is  claimed,  will  follow^,  and  a  tooth 
may  be  extracted  without  pain.  During  the  thaw^- 
ing,  care  must  be  observed  in  the  use  of  hot  water, 
if  used  too  hot  or  too  soon  sloughing  will  foUow^. 


CELLULITIS. 

See  Phlegmonous  Erysipelas. 
10 


130         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

CERUMEN,  INSPISSATED  AND  IM- 
PACTED. 

Vaseline,  Olive  Oil,  or  Glycerine  : — The  latter  the 
most  effective,  warmed  and  dropped  into  the  ear  and 
retained  by  pledgets  of  cotton,  are  useful  for  soften- 
ing the  wax  before  syringing.  The  oil  and  glycerine 
should  be  allowed  to  remain  tw^enty-four  hours. 
(Bp.) 

Sodium  Bicarbonate : — Gr.  iv— Ij,  with  warm  water 
or  glycerine ;  fill  the  ear  several  times  a  day  w^ith  the 
solution;  allow  it  to  remain  for  about  fifteen  min- 
utes, the  mass  wnll  then  break  up  and  can  be  easily 
removed  by  injection.  The  auditory  canal  should 
afterwards  be  dried,  anointed  with  vaseline,  and 
protected  w^ith  cotton.     (Bp.) 

Papain: — Gr.  xx-§j.  Liquor  Potassae: — 10  per  cent, 
solution. 

Hydrogen  Peroxide: — Injections  of  full  strength 
are  very  effective.     (Al.) 

CHAFING. 

See  Erythema  Intertrigo. 

CHANCRE,  HARD. 

Strict  cleanliness  is  of  great  importance.  The  part 
should  be  bathed  frequently  in  tepid  w^ater  or  some 
antiseptic  lotion.     Usually  simple  dressings  in  the 


CHANCRE,   HARD.  131 

form  of  dusting  powder  are  effective  in  healing  the 
local  sore.  Iodoform  formerly  headed  the  list,  but 
some  of  the  odorless  dusting  powders  may  be  substi- 
tuted, such  as  Aristol,  Europhen,  or  Bismuth  Sub- 
nitrate.  Sometimes  a  simple  piece  of  lint  laid  on  the 
erosion  will  be  all  that  is  necessary.     (CI.) 

Calomel: — Used  as  a  dry  dressing  w^ith  equal  parts 
of  zinc  oxide.     (B.  H.) 

Hydrogen  Peroxide  : — Wash  the  part  three  times  a 
day  in  the  pure  peroxide  and  apply  lint  soaked  in  the 
same.     (R.) 

Lotio  Nigra  and  Lotio  Flava: — Old  but  none  the 
less  effective  remedies,  especially  for  indolent  sores. 
(N.) 

Ung.  Hydrarg.: — If  there  is  much  induration  the 
official  ointment  may  be  used,  protecting  the  sur- 
rounding part  by  proper  dressings ;  or  if  this  is  too 
irritating  the  following : 


». 

Hydrarg.  Prgecipitat. 

Alb., 

gr.  xl. 

Adipis  Benzoat., 

U 

M. 

ir 

Ung.  Hydrarg., 
Zinc.  Oxidi, 

Amyli, 

aa  ^ij. 

Adipis  Benzoat., 

IJ- 

M. 

(B.  H.) 

The  weight  of  evidence  is  strongly  against  the 
utility  of  excision  and  cauterization,  as  well  as  the 
eflfectiveness  of  antiseptic  lotions  and  local  applica- 
tions of  mercury  as  preventives  or  abortives  of 
constitutional  symptoms. 

If -the  chancre  does  not  heal  but  presents  an  exten- 
sive ulcerating  surface,  or  appears  to  be  of  the  mixed 


132  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

variety,  the  same  treatment  as  for  chancroid  will  be 
indicated. 


CHANCROID. 

It  has  long  been  the  custom  with  many  surgeons 
to  cauterize  all  chancroids;  but  modem  antisepsis 
has  modified  this  routine  treatment.  In  a  large 
majority  of  cases  daily  irrigation  with  a  solution  of 
Corrosive  Sublimate,  1-500  or  1-1000,  followed  by 
the  free  application  of  Iodoform,  or  an  ointment  of 
the  same,  in  the  strength  of  90  grains  to  vaseline  1 
ounce  will  be  followed  by  cicatrization.  If  this  fails, 
pledgets  of  lint  soaked  in  Boric  Acid  solution  or  in 
Peroxide  of  Hydrogen  kept  continuoush'  applied 
will  often  result  in  a  cure.  Should,  however,  these 
measures  in  turn  prove  unsuccessful  and  the  sore 
deepen  and  extend,  it  should  be  cauterized.     (A.) 

Cauterants. 

Cauterization  is  recommended  bj^  not  a  few  au- 
thorities as  the  first  remedial  measure;  but  others 
limit  its  application  to  those  cases  in  which  anti- 
septic treatment  has  failed  and  to  the  severer  forms 
of  the  lesion.  Before  application  the  sore  should  first 
be  cleansed  and  dried. 

The  contra-indications  for  the  uses  of  cauterizing 
agents  are  w^hen  the  surface  involved  is  large  and 
there  is  evidence  of  healthy  reaction  about  to  take 
place ;  when  there  is  much  inflammation ;  and  when 
the  sore  is  situated  at  the  meatus  urinarius.  The 
objections  to  their  use  are  the  pain  and  inflamma- 
tory action  which  follows,  the  possible  production 


CHANCROID.  133 

of  phimosis  and  the  subsequent  effusion  of  lymph, 
which  is  apt  to  cause  indurations  closely  resembling 
hard  chancre,  and  thus  obscure  diagnosis.     (A.) 

Nitric  Acid : — The  most  frequently  used  cauterant, 
should  be  applied  as  follows :  The  chancroid  is  dried 
with  absorbent  cotton;  then  cleansed  with  hydro- 
gen peroxide  and  again  dried.  The  parts  are  now^  so 
held  as  to  give  them  as  much  as  possible  a  cup-like 
depression  looking  upward.  This  is  filled  with  one 
drop  or  more  of  the  acid  by  means  of  a  glass  rod ;  in 
a  few  minutes  the  part  will  turn  white.  The  acid 
should  be  allowed  to  overlap  the  original  margin  of 
the  sore.  The  superabundant  acid  must  now  be  re- 
moved with  cotton  and  a  drop  of  carbolic  acid  ap- 
plied to  relieve  the  pain;  the  ulcer  is  now  dressed 
with  a  dusting  powder.    (CI.) 

Sulphuric  Acid : — This  is  hardly  to  be  preferred  to 
nitric  acid,  as  it  penetrates  more  deeply  and  is  not 
easily  controlled.  Combined  with  charcoal  (Ricord's 
Paste),  with  asbestos  (Michel's  Paste),  or  w^ith 
saifron  (Velpeau's  Paste),  it  is  more  manageable. 
(F.)  It  should  be  pressed  down  well  into  the  irregu- 
larities of  the  surface,  where  it  remains  a  black 
crust ;  after  a  few  days  will  come  away  and  leave  a 
health}^  surface.     (CI.) 

Acid  Nitrate  of  Mercury: — One  of  the  best  caus- 
tics ;  apply  with  a  glass  rod.     (B.) 

Actual  Cautery  : — This  agent  acts  well  when  the 
lesions  are  small  and  few  in  number.  It  should  bum 
deepl}^  so  that  the  surface  of  the  sores  are  well 
charred.  Apply  cold  water  dressings  until  the  eschar 
comes  off.     (CI.) 

Radiant  Heat:  —  The  thermo-cauterj'-  is  brought 
close  to  the  sore,  but  not  in  actual  contact,  and  held 


134         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

there  for  a  few  seconds.  This  dries  up  the  ulcer,  upon 
the  edges  of  which  sanguinolent  striae  appear.  Too 
long  application  should  be  avoided  lest  blisters 
form.  A  single  application  will  transfer  the  lesion 
into  a  simple  ulcer,  w^hich  will  heal  rapidly  under 
antiseptic  powders;  more  so  than  when  the  actual 
cautery  is  used.     (D.  H.) 

Dressings  : — General  indications  may  be  summar- 
ized as  follows:  For  acute  inflamed  and  painful 
sores,  sedative  lotions,  such  as  lead  water,  lead  and 
opium  wash,  sulphate  of  zinc  and  opium ;  for  indo- 
lent pale  ulcerations,  stimulating  applications,  such 
as  strong  zinc  solutions,  nitrate  of  silver,  etc.    (A.) 

All  dressings  should  be  removed  with  great  care ;  if 
adherent,  they  should  be  softened  in  order  to  avoid 
tearing  the  sore,  thus  favoring  re-inoculation. 

Moist  Dressings: — 

Hydrogen  Peroxide, 

Mercuric  Bichloride,  1-3000  or  4000. 

Carbolic  Acid,  1-60. 

The  sore  should  be  sprayed  with  the  selected  solu- 
tion and  a  pledget  of  lint  soaked  in  the  same  kept 
applied  and  changed  three  times  a  day.     (CI.) 

Dry  Dressings: — These  are  indicated  at  any  and  all 
times. 

Iodoform : — This  remedy  stands  first.  Holmes  said 
that  the  treatment  of  chancroid  is  now  reduced  to  a 
simple  matter  in  the  majority  of  cases.  There  are 
few  which  will  not  yield  to  the  application  of  iodo- 
form.    (HI.) 

Europhen,  Di-iodoform,  Acetanilid,  Aristol,Xero- 
form,  Traumatol,  etc.,  the  last  has  been  used  with 
great  success  as  a  substitute  for  iodoform ;  it  has  the 


CHANCROID.  135 

advantage  of  being  non-poisonous  and  non-irritat- 
ing.    (F.) 

Calomel: — Usefiil  to  complete  the  healing  process. 
(CI.) 

Guaiacol: — Gently  applied  at  first  in  order  to  anaes- 
thetize, then  mopped  on  freely,  for  its  caustic  eifect, 
is  reported  to  have  brought  about  a  speedy  cure  in 
all  but  one  of  thirty  cases.     (J.  de  P.) 

Bromine: — 10  minims  to  1  ounce  of  olive  oil  forms 
a  sedative  dressing.     (Sm.) 

Cocaine  : — 4  per  cent,  or  stronger  solutions  to 
render  cauterization  painless.     (Al.) 

Pyrogallic  Acid: — As  a  powder,  25  per  cent,  with 
starch  or  a  5  per  cent,  paste  acts  w^ell.  It  does  not 
attack  healthy  skin.  Apply  night  and  morning  and 
cover  with  gutta  percha.  It  should  be  continued 
until  granulations  appear,  after  v^hich  oxide  of  zinc 
or  calomel  should  be  dusted  on.     (CI.) 

Alumnol: — 10  per  cent,  dusting  powders  are  use- 
ful.    (F.) 

Pixol : — 10  to  13  per  cent,  solutions  painted  on  the 
sore  will  promote  healing.     (F.) 

Iodoform  and  Glycerine: — May  be  preferred  to 
iodoform  alone  as  an  application  to  crevices.  (D.  H.) 

Hot  ^A^ater: — When  there  is  extensive  inflamma- 
tion, immersion  of  the  part  in  a  cup  of  hot  water 
three  or  four  times  of  day  or  a  prolonged  sitz  bath 
are  very  beneficial.     (D.  H.) 

Charcoal  Poultice  and  Potassium  Permanganate 
in  weak  solutions  are  indicated  when  the  sore  is 
gangrenous.     (CI.) 

Ointments  hold  a  secondary  position  and  are  con- 
demned   by  some  observers.    They  may,  however, 


136  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

prove  preferable  in  some  cases.    The  following  are 
recommended : 


9;.    Hydrarg.  Chloridi  Mitis, 

gr.  X. 

Naphthalini, 

3J- 

Ung.  Camphorae, 

3vij. 

M. 

Or, 

Vi.    Pyoktanin.  (Blue), 

Potass.  Bicarb., 

aa  gr.  xv. 

Aq.  Destill., 

I"j- 

Alcohol, 

3v. 

Reduce  by  heat  to  J  iij 

and  add 

Pyoktanin.  (Blue), 

Sod.  Biborat., 

aa  gr.  xv. 

Aq.  Destill., 

5  iij. 

M. 

Or, 

J^.    Resorcini, 

3j-ij- 

Vaselini, 

U 

M. 

(S.  M.) 

Subpreputial  Chancroids: — Inject  warm  salt  water 
every  two  or  three  hours,  following  with  a  solution 
of  Potass.  Permang.  gr.  j— x— gj,  or  Nitrate  of  Silver 
gr.  X— XV— 5J,  or  a  mixture  of  Balsam  of  Peru  and 
Iodoform.  An  offensive  odor  from  the  discharge 
indicates  a  tendency  to  gangrene.  In  this  case  the 
prepuce  should  be  slit  up,  the  glans  penis  exposed, 
and  the  appropriate  treatment  applied.  When  the 
fraenum  has  been  destroyed  it  should  be  ligated  or 
cauterized.     (CI.) 

PHAGEDENIC    CHANCROID.      See  also    Phage- 
daena. 

Rest    in  bed    with    antiseptic    dressings,  notably 


CHAPS  AND  FISSURES  OF  THE  HANDS.  137 

Iodoform  The  Acid  Cauterants  as  mentioned  are 
generally  indicated.  Curettage  is  recommended  by 
Carleton  before  the  application  of  nitric  acid. 

Potassium  Permanganate  : — Gr.  xl-lx-§j  for  ap- 
plication to  the  sore ;  then  dress  with  lint  saturated 
in  a  solution  of  gr.  j-ij-§j.     (D.  H.) 

Menthol-Phenol : — 3  per  cent,  in  hot  water  for 
bathing  the  part  frequently.    (F.) 

Carbolic  Acid  : — A  few  drops  of  the  pure  acid  ap- 
plied daily.  Pyrogallic  Acid  and  Sulphuric  Acid 
paste  as  mentioned. 

Bromine : — Solution  of  1-500  for  continuous  ap- 
plication.    (CI.) 

Hot  Water: — Immersion  of  the  part  in  hot  A?\rater, 
as  recommended  for  inflammation,  is  also  beneficial 
in  this  form.     (Ga.) 

Actual  Cautery  : — If  milder  measures  fail,  apply  the 
Paquelin  or  galvano-cautery ;  the  latter  is  decidedly 
preferable  as  it  is  more  easily  controlled.  Cases 
w^hich  have  resisted  all  other  measures  may  be  ar- 
rested by  this  agent. 

Boric  Acid: — Saturated  solutions  are  serviceable 
dressings  after  cauterization. 


CHAPS   AND    FISSURES    OF    THE 
HANDS  AND  LIPS. 

Bismuth  Subnitrate,  as  a  powder.  Rose  Water 
Ointment,  Cold  Cream,  Glycerine  with  Egg  Yolk  or 
with  equal  parts  of  Bay  Rum,  or  with  equal  parts  of 
Benzoin,  Glycerol  of  Starch,  Lanolin,  Mutton  Suet, 
Nitrate  of  Lead  gr.  x— |j  (the  last  as  a  secret  remedy 


138  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

is  much  emploA^ed  in  Europe),  all  useful  for  the  hands 
or  lips. 
The  following  are  also  of  service : 


9;.    Camphorse, 

3ss. 

Acid.  Carbolici, 

M.iv, 

Ol.  Neroli, 

M.iij 

Sevi, 

Sij- 

M. 

Sig.     Soften  a  small  bit  and  apply. 

ife.    Hydrarg.  Oxid.  Rub., 

3"j. 

Cerat.  Benzoin., 

5J. 

M. 

(Sm.) 

For  fissured  lips  and  cracks  at  the  comers  of  the 
mouth,  the  fissure  should  be  filled  and  distended  with 
the  ointment  repeatedly.  A  cicatricial  tissue  will  be 
produced  which  will  prevent  subsequent  Assuring. 

Gutta-percha  in  solution,  or  Collodion  : — As  pro- 
tect ives. 

The  following  are  for  chapped  hands : 

9;.    Mentholi,  gr.  x. 

Ol.  Olivae, 

Saloli,  aa  M.xx. 

Lanolini,  5^^- 

M. 
Sig.     Apply  twice  daily. 

1^.    I/anolini,  5"j- 

Glycerini,  3^^- 

Acid.  Borici,  3^^- 

Saloli,  3j. 

Mentholi,  gr.  xv. 

01.  Citronellae,  M.iij. 

M.  (T.,98.)" 

Emol  Keleet : — Said  to  be  the  best  preparation  for 
deeply  fissured  skin. 


CHILBLAIN.  139 

9;.    Emol.  Keleet. ,  Sij- 

Zinc.  Oxid.,  5j- 

Glycerini  Plumb.  Subacetat.,  q.s. 

Lanolini,  Sss. 

Vaselini,  5^- 

M.  (T.,98.) 

Use  sufficient  glycerine  of  acetate  of  lead  to  form  the  powder 
into  a  paste,  then  add  the  lanolin  and  vaseline. 

It  should  be  applied  at  night  and  the  hand  covered  with  lint. 

Cerates  of  Hydrastis,  Calendula,  Graphites,  Borax. 
Court  Plaster  will  often  speedily  heal  fissures  on  the 
hands  in  some  persons. 


CHILBLAIN. 

General  indications  in  the  chronic  form  when  the 
skin  is  unbroken  call  for  stimulating  and  astringent 
applications ;  in  especially  chronic  cases  galvanism  is 
effective.  When  ulcers  form  they  must  be  treated  on 
general  principles. 

The  following  applied  by  painting  on  the  affected 
part  are  recommended  when  the  skin  is  unbroken: 
Tr.  Tamus  Comniunis  and  Tr.  Benzoin.  Great 
claims  are  made  for  both  these  remedies.  Oil  of  Caju- 
put,  Tr.  Capsicum,  diluted,  or  Oil  of  Black  Pepper 
and  Tr.  Cantharidis,  equal  parts,  Collodion  and 
Glycerine,  equal  parts,  Tr. Iodine,  Tr.  Aconite  to 
allaA^  the  burning  and  tingling.     (AL,  Rd.,  Kp.,  Bt.) 

Turpentine: — In  combination  as  follows : 

Venice  Turpentine,  3  vj . 

Collodion,  gij. 

Castor  Oil,  ^iij. 

When  there  is  great  tenderness  of  the  surface ;  or 


140  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Oil  of  Turpentine,  3ss. 

Naphthol,  gr.  xv. 

Lanolin,  ^ss. 
M.  (Sh.) 

Tr.  Rhus  Tox.,  3ss-^j,  Tr.  Calendula,  or  Tr. 
Hamamelis,  1  part  of  either  to  4  of  water.     (Rd.) 

Wet  Compresses  covered  with  oiled  silk  will  afford 
marked  relief.  Fomentations  of  Flaxseed  Meal  or 
Marsh  Mallow  are  also  useful  for  relieving  pains. 
(Bt.) 

Ichthyol : — This  is  an  effective  remedy,  and  is  used 
with  equal  parts  of  Resorcin  and  Tannin  in  150 
parts  of  water ;  the  mixture  must  be  well  shaken  be- 
fore applying.  The  affected  parts  should  be  painted 
at  night.  After  the  first  application  it  forms  a 
glazed  surface.  Under  its  influence  the  skin  shrivels 
and  the  cedema  as  well  as  the  chilblains  disappear. 
(T.,  97.) 

Carbolic  Acid: — Used  in  various  ways  with  good 
results ;  a  5  per  cent,  solution ;  or  the  follow^ing  oint- 
ments : 

p.    Acid.  Carbolici,  gr.  xvss. 

Ung.  Plumbi, 

Lanolini,  aa  ^v. 

Ol.  Amygdalae,  3iiss. 

01.  Lavandulae,  gtt.  xx. 

M.  (Al.) 

9;.    Acid.  Carbolici,  3J. 

Tr.  lodi,  3ij. 

Acid.  Tannici,  jij. 

Cerat.  Simp.,  ^iv. 
M.  (B.) 

^.    Acid.  Carbolici,  gr.  iij. 

Lanolini,  3ss. 

Pulv.  Camphor.,  gss. 
M.  (Sh.) 


CHILBLAIN.  141 

Plumbi  Acetas,  viz.: 

Ijfc.    Plumbi  Subacetat.,  9ijss. 

Cerae  flavse,  3Jss. 

Ol.  Rapi,  gj. 

Ovi  Vitelli,  No.  j. 
M. 

ffc.    Liq.  Plumbi  Subacetat., 

Creosoti,  aa  gtt.  x. 

Ext.  Opii,  gr.  iss. 

Adipis,  Jj. 

M.  (Al.) 

Aconite  with  Chloroform  Liniment  is  one  of  the 
best  applications;  Sulphurous  Acid,  5J-5J,  with  a 
little  glycerine,  acts  quickly  (Bt.);  Wardrop's  Lini- 
ment, 2  parts  of  tr.  cantharides  with  6  parts  of  soap 
liniment;  Mustard  Foot  Bath  for  the  itching.     (HI.) 

Decoction  of  "Walnut  Leaves  is  useful  for  bathing 
the  parts,  which  should  be  then  dried  and  rubbed 
with  Spts.  Camphor ;  after  this  dust  on  Salicylate  of 
Bismuth,  10  per  cent,  in  powdered  starch.     (Sj.) 

Resorcin: — Sometimes  is  very  effective  it  may  be 
used  as  follows : 

Resorcin,  i  part. 

Ichthyol,  I  part. 

Tannic  Acid,  i  part. 

Water,  5  parts. 

The  mixture  must  be  shaken  and  painted  on  at 
night.  It  is  not  to  be  applied  in  irritable  chilblain. 
It  dries  the  skin  and  is  sometimes  badly  borne.  (T., 
97.) 

The  following  ointments  are  of  service:  Ung.  Bal- 
sam. Peru.,  Ung  Zinci  Oxidi,  Ung.  lodi.  When 
ulceration  appears  the  following : 


142  DIGEST   OF   EXTERNAL   THERAPEUTICS. 


T^. 

Balsam.  Peru., 

3j. 

Ung.  Hydrarg.  Nit., 

3ij. 

Zinc.  Carb., 

SJ- 

Ung.  Aq.  Rosae, 

33- 

M. 

Ung.  Plumbi  Subacetat., 

gss. 

Ext.  Arnicse, 

3ss. 

Ext.  Cocae  Erythrox., 

3ss. 

Ol.  Anthemidis, 

gtt.  V. 

Ung.  Aq.  Rosae, 

§ss. 

M. 

(Sh.) 


CHLOASMA. 

See    Lentigo. 

In  selecting  local  applications  great  care  should  be 
exercised  to  avoid  the  use  of  agents  which  may  cause, 
discoloration  of  the  skin,  such  as  mineral  acids,  mus- 
tard or  croton  oil.     (Sh.) 

Hydrarg.  Bichlorid.: — This  remedy  is  much  used; 
the  following  are  some  of  its  methods  of  applica- 
tion: 

9;.    Hydrarg.  Bichlorid.,  gr.  iij. 

Aq.  Destill.,  5j. 

M.  (Pf.) 

Or, 

$fc.    Hydrarg.  Bichlorid.,  gr.  ij. 

Emulsion.  Amygdal.,  ,^j. 

M.  (Kp..) 

Sig.     Apply  night  and  morning. 

Hebra's  method  consists  of  applying  a  solution  of 
the  bichloride,  gr.  v— ^',  by  means  of  a  compress,  for 


CHLOASMA.  143 

five  hours.     A  blister  will  result  which  should  be 
punctured  and  powdered  with  starch.    The  new  epi- 
dermis will  be  lighter  but  it  will  not  remain  so.  (Sh.) 
Bulkley  recommends  the  foUow^ing : 

Ipfe.    Hydrarg.  Bichlorid.,  gr.  vj. 

Acid.  Acetici  Dilut.,  3^j- 

Boracis,  9ij. 

Aq.  Rosae,  ad  5iv. 

M. 

To  be  applied  night  and  morning,  at  first  gently 
brushed  over  the  afiected  part,  then  afterwards 
rubbed  on.  If  the  skin  becomes  too  scaly,  suspend 
the  application  for  a  day  or  two  and  apply  vaseline. 

A  combination  with  lemon  juice  acts  well,  viz.: 

9;.    Hydrarg.  bichlord.,  gr.  iv. 

Succi  Lemonis,  gij. 

Aq.  Destill.,  S^vj. 

M. 

Sig.     Apply  a  small  amount  with  a  soft  cloth  each  morning 
and  allow  it  to  dry  on  the  skin. 

In  a  few  days  a  bran-like  exfoliation  of  the  super- 
ficial epidermis,  containing  more  or  less  of  the  pig- 
mentation, will  occur.  This  process  may  be  repeated 
(with  intervals  of  rest  in  application  to  prevent  sore- 
ness from  a  too  constant  use)  as  long  as  pigmenta- 
tion is  apparent.     (M.  H.,  2,  99.) 

The  following  is  also  recommended : 

9.    Hydrarg.  Bichlorid.,  gr.  vss. 

Zinc.  Sulphatis, 

Plumbi  Subacetatis,  aa  5ss. 

Aquae,  gv. 

M.  (Vn.) 

Unna  first  washes  the  part  with  Spirits  of  \A^ine 
then    applies  a   Mercurial    Plaster    made  from  the 


144  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

White   Precipitate;    this  is  allowed  to  remain  on 
over  night  and  the  following  used : 

^.    Bismuth.  Subnitratis,  5ss. 

Kaolini,  5^- 

Vaselini,  '  3vj-Siss. 

M.  (Sh.) 

Copper  Oleate  : — In  oleo-palmetic  acid,  sufficient  to 
make  a  soft  ointment,  is  recommended  by  Kippax. 

Ung.  Hydrarg.  Oleate,  Ung.  Hydrarg.  Nitrate,  pure 
or  diluted;  Tr.  Iodine,  Veratria,  gr.  x— xxx— §j ; 
Potash  Soap,  applied  continuously  for  four  hours 
or  the  entire  day.  (Sh.)  Tr.  Benzoin,  equal  parts 
w^ith  alcohol,  applied  daily  until  desquamation  oc- 
curs.    (Pf.) 


CHOLERA   ASIATICA. 

Method  ofCantani: — This  is  indicated  in  the  stage 
of  serous  diarrhoea  and  in  the  algid  state.  (An.)  It 
consists  essentially  in  supplying  to  the  system  the 
w^ater  of  which  it  has  been  deprived ;  this  may  be 
accomplished  by  intestinal  injections  of  water, 
enteroclysis,  and  hjrpodermic  injection,  hypoder- 
moclysis.     (Gn.) 

Enteroclysis : — Indicated  in  the  premonitory  diar- 
rhoea. It  may  be  administered  by  a  long  rectal  tube. 
To  secure  retention  it  must  be  given  slowly ;  if  ex- 
pelled it  will  serve  the  purpose  of  irrigation,  but 
should  be  persisted  in.  The  injection  should  consist 
of  an  infusion  of  chamomile  containing  5  to  25 
grams  of  tannic  acid,  and  20  to  30  drops  of  lauda- 


CHOLERA   ASIATIC  A.  145 

num,  and  20  to  50  grams  of  gum  arable.  The  tem- 
perature of  the  fluid  should  be  100°  to  104°.  The 
dose  for  an  adult  is  from  1  to  2  quarts.  The  injec- 
tions should  be  repeated  four  times  a  day,  and  in 
grave  cases  after  each  movement.     (Gn.) 

The  formula  of  Cantani  is  elsew^here  given  with 
■water  as  a  base  instead  of  infusion  of  chamomile 
and  ^vine  of  opium  instead  of  laudanum.     (Sm.) 

Hypodemoclysis  : — In  the  later  or  algid  stage,  hy- 
podermic injections  of  artificial  serum  are  indi- 
cated. This  is  accomplished  with  a  fountain  syringe 
to  which  a  perforated  needle  is  attached.  Strict  anti- 
sepsis should  be  observed  in  all  details.  The  artificial 
serum  consists  of  the  foUow^ing : 

Sodium  Chloride,  4  grams. 

Sodium  Carbonate,  3  grams. 

Sterilized  Water,  i  litre. 

This  amount  is  to  be  inserted  at  one  time  and  re- 
peated subsequently  as  required.  The  temperature 
of  the  fluid  should  be  100°  to  104°  or  higher  if  it  can 
be  tolerated,     (Gn.) 

The  points  of  injection  are  usually  the  buttocks, 
flank,  thighs  or  below  the  pectoral  muscles. 

Intravenous  Injections  of  Saline  or  Milk: — These 
are  indicated  in  the  algid  stage,  but  hypodermoclysis 
is  to  be  preferred.  (Gn.)  A  formula  for  the  saline 
fluid  is  as  follows : 

Sodium  Sulphate,  3"^- 

Sodium  Chloride,  5j' 

Distilled  Water,  Oij. 
Inject  6  ounces  slowly.  (T.,  98.) 

Normal  Saline    Solution : — This  may  be  used  for 
hypodermoch'sis  and  intravenous  injection  in  place 
of  more  complex  solutions.    See  Appendix  II. 
11 


146         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Mustard  Sinapisms: — Large  size  plasters  to  the 
epigastrium  and  abdomen  for  the  rehef  of  vomiting 
and  pain.     (Gn.) 

Heat: — Hot  A^vater  bags  and  bottles,  flannels 
wrung  out  in  hot  \vater  applied  to  the  abdomen 
and  frequently  changed  are  used  for  the  relief  of 
pain.     (Gn.) 

Stimulation  of  the  Surface  bj'  friction,  kneading 
and  rubbing  with  mustard  water  to  relieve  cramps 
and  to  stimulate  the  circulation  should  be  employed. 
(Gn.) 

Methylene  Violet: — 15  to  45  minims  of  a  1  per 
cent,  solution  subcutaneously  every  three  or  four 
hours.     (Sj.) 

Chloral  Hydrate  and  Morphine: — The  following  to 
be  given  subcutaneously  in  doses  of  15  to  30  minims 
is  highly  recommended  for  the  collapse : 

Chloral  Hydrate,  3"j- 

Morphia  Sulphate,  gr.  iv. 

Cherry  Laurel  Water,  5J- 

The  injection  will  cause  burning  and  irritation,  but 
according  to  Bartholow  suppuration  does  not  fol- 
io w^. 

Camphor : — Subcutaneous  injections  of  camphor 
dissolved  in  olive  oil  can  be  administered  with  good 
effect  in  20  minim  doses  in  conjunction  with  Can- 
tani's  method.     (Y.) 

Nitro-Glycerine,  Atropine  and  Ether  hypodermic- 
ally  for  stimulating  the  heart.     (Bt.) 

In  severe  cases  all  medicines  may  be  administered 
hypodermically  for  speedy  action.     (Bt.) 

After  vomiting,  the  patient's  mouth  should  be 
rinsed  with  a  solution  of  Hydronaphthol,  1-5000, 


CHOLERA   INFANTUM.  147 

taking  care  that  none  is  swallowed,  and  after  each 
movement  the  buttocks,  thighs  and  anus  should  be 
washed  with  soap  and  water.  All  vomited  matter 
and  discharges  from  the  bo\\^els  should  be  gathered 
in  a  solution  of  carbolic  acid  1-20,  or  chlorinated 
lime  1-10,  some  of  which  should  be  in  the  vessel 
when  used.  The  water  thus  collected  should  be 
mixed  with  more  of  the  disinfectant,  stirred  and  al- 
lowed to  stand  twenty  minutes  before  throwing  into 
the  closet.     (Ty.) 


CHOLERA  INFANTUM. 

\Vashing  out  the  Stomach  and  Irrigation  of  the 
Colon  : — These  are  very  important  measures  for  the 
removal  of  the  poison,  which  is  one  of  the  first  indi- 
cations of  treatment.  The  irrigation  of  the  intestines 
should  be  thorough,  using  sterilized  water,  with  or 
wdthout  Castile  soap.  The  water  may  be  tepid,  or 
cold  if  the  temperature  is  high,  and  the  irrigation 
continued  until  it  comes  out  clear.  This  procedure 
should  be  repeated  on  the  return  of  the  vomiting  and 
purging.  A  flexible  rubber  catheter  introduced  six  or 
eight  inches  may  be  used  for  the  bowel.  Objections 
to  these  methods  on  account  of  their  supposed  sever- 
ity are  mostly  imaginary.     (Gn.) 

Opium: — Must  be  used  with  extreme  caution  in 
young  children,  w^ho  are  very  susceptible  to  its  in- 
fluence. It  is  valuable  w^hen  there  is  much  pain  and 
irritability,  and  may  be  administered  by  enema, 
2  to  5  drops  in  starch  to  an  infant  six  to  twelve 
months  old.    The  effect  must  be  carefully  watched. 


148  DIGEST   OF    EXTERNAL   THERAPEUTICS. 

The  dose  may  be  repeated  in  from  six  to  twelve 
hours  if  necessar^^     (A.  W.) 

Morphine  and  Atropine: — These  drugs  must  also 
be  administered  with  great  care  to  young  children. 
Holt  gives  Y^Tj-  grain  of  morphine  with  ^^-^  grain  of 
atropia  for  the  first  dose  to  an  infant  of  one  year. 
When  stupor  or  collapse  seems  imminent,  thej-  are 
especially  contra-indicated.  (An.)  The  indications 
are  the  same  as  those  calling  for  opium.  These  rem- 
edies are  not  often  required,  as  others  administered 
by  the  mouth  render  their  use  \&ry  infrequent ;  they 
are  nevertheless  at  times  invaluable. 

Subcutaneous  Saline  Injection: — As  it  is  impossi- 
ble to  supply  water  to  the  exhausted  tissues  133-  the 
mouth  or  rectum,  injection  into  the  cellular  tissues 
of  the  thighs  and  buttocks  of  a  solution  of  4  grains 
of  common  salt  to  a  pint  of  sterilized  water  may 
be  practiced  with  good  effect.  One  pint,  and  often 
larger  quantities,  may  be  thus  administered  in 
twenty-four  hours  with  advantage.  (An.)  See 
Normal  Saline  Solution,  Appendix  II. 

Salicylic  Acid : — 5  grains  in  starch  by  injection  has 
done  good  service.  (Bt.)  Hot  Mustard  Baths: — In 
bad  cases  for  the  relief  of  intestinal  congestion  and 
cutaneous  circulation.  (F.)  Brandy  Compresses: — 
Cloths  soaked  in  brandy  laid  over  the  abdomen  and 
covered  with  oiled  silk.     (Bt.) 

Ice  Bag: — Maj-  be  applied  to  the  spine  for  the  relief 
of  cramps  of  the  legs  (Gn.)  and  to  the  head  to  con- 
trol temperature.     (An.) 

Cool  Sponging : — With  gentle  friction  may  be  used 
frequently  if  there  is  much  fever.     (Gn.,  A.  W.) 

Keep  the  abdomen  and  extremities  covered  with 
flannel  and  the  child  out  in  the  open  air  as  much  as 


CHORDEE.  149 

possible.    A  cool  place  should  be  selected  if  practi- 
cable, but  care  should  be  observed  not  to  chill. 


CHORDEE. 

Cold: — Its  application  in  some  form,  such  as  ice, 
cold  metal  or  immersing  the  penis  in  cold  water  or  a 
cold  sitz  bath  is  usually  effective. 

Gallobromal: — Urethral  injections  of  1  to  2  per 
cent,  solutions.     (F.) 

Hop  Poultice: — Applied  to  the  penis  during  gonor- 
rhoea will  assist  in  preventing. 

Morphia: — Subcutaneously  in  doses  of  ^  grain  be- 
fore retiring. 

Suppositories  containing  Belladonna  or  Opium 
are  effective,  but,  as  a  rule,  cause  constipation;  if 
necessary,  the  follow^ing  is  suggested : 

Opium,  I  grain. 

Powd.  Camphor,  3  grains. 

Oil  of  Theobroma,  q.  s. 

(A.) 

Leeches: — In  obstinate  cases  these  will  prove 
valuable;  eight  to  ten  ounces  of  blood  may  be  ab- 
stracted. For  the  following  two  or  three  days  the 
patient  should  occupy  a  strictly  recumbent  posture. 
(A.) 


CHOREA. 

Hydrotherapy:— The  wet  pack  is  advised  as  effect- 
ive. A  sheet  is  dipped  in  water  at  50°  to  54°,  then 
lightly  wrung  out,   spread  on  a  mattress  covered 


150  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

with  oiled  cloth,  then  closely  wrapped  around  the 
patient  who  is  rubbed  from  head  to  foot  and  placed 
betw^een  woolen  blankets  and  returned  to  bed.  (Sj.) 
The  spinal  douche  is  also  employed,  the  temperature 
of  the  water  varying,  according  to  the  severity  of 
the  case,  from  lukewarm  in  the  beginning  to  colder, 
lowering  the  temperature  day  by  day  as  the  patient 
improves.     (T.,  96.) 

Electricity: — Central  galvanization  and  general 
faradization  act  favorably.  The  galvanic  current  is 
preferable  for  vigorous  children,  the  faradic  for  the 
anaemic  and  weak.  (Sj.)  Static  electricity  often 
gives  brilliant  results;  some  cases  may  be  treated 
by  the  constant  current  and  the  static  in  combina- 
tion.    (Bw.) 

Systematic  Muscular  Exercise  : — Has  been  success- 
ful in  cases  of  long  standing.     (T.,  98.) 

Rest : — Put  the  patient  in  bed  and  keep  him  there 
according  to  the  severity  of  the  case,  three  v^eeks 
being  usually  necessary.  The  rest  should  be  complete 
both  mentally  and  physically.     (Sj.) 


CICATRICES. 

Massage  and  Electricity: — Galvanism,  electro-mas- 
sage (faradism)  and  electrolysis  are  all  employed, 
the  latter  especially,  for  the  removal  of  hardened  and 
hypertrophied  new  formations,  and  for  atrophic  cic- 
atrices when  not  very  numerous.     (F.) 

The  following  applied  to  granulating  surfaces  will 
prevent,  it  is  claimed,  scars  appearing  unsightly : 


COLD,    EFFECTS   OF.  151 

9;.    Sod.  Biboratis,  3^^- 

Sod.  Salicylatis,  gr.  xij. 

Glycerini,  3"j- 

Aquas  Rosse,  5^3- 

M. 

Sig.     Apply  frequently. 

Or, 

^.    Ferri  Chloridi,  3j. 

Colodii,  3ij- 

M.  (Bt.) 

Thiosinamine: — Cicatricial  contractiires  have  been 
greatly  benefited  by  hypodermic  injections  of  this 
drug  in  alcoholic  solution,  15 per  cent.,  or  in  solution 
with  equal  parts  of  glycerine  and  water ;  the  latter 
is  not  as  painful  as  in  alcohol  and  is  just  as  active. 
Ectropion  from  lupus,  talipes  equinus,  etc.,  have 
been  much  benefited  by  its  use.  The  dose  is  V2  to  % 
grain  tmce  daily  at  the  beginning,  and  gradually  in- 
creased, rarely  exceeding  1%  grains.  Hebra  seldom 
gave  as  much  as  3  grains,  beginning  with  the  smallest 
dose,  though  other  observers  cited  by  him  gave  as 
much  as  4  grains,  commencing  with  the  smallest 
dose.  Hebra  suspended  treatment  for  ten  days  every 
six  weeks  to  two  months.     (F.) 

Excision: — When  the  neighboring  parts  and  the 
surrounding  tissues  admit,  plastic  surgery  should  be 
considered. 


COLD,  EFFECTS  OF. 

FROST  BITE. 

Gradual  Application  of  ^A^armth : — While  there  is 
some  difference  of  opinion  as  to  whether  warmth 


152  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

should  be  gradualh-  or  suddenly  applied,  the  ma- 
jority of  obser^-ers  favor  a  gradual  transition  from 
cold  to  heat,  which  nia3'  be  employed  in  the  follo\sr- 
ing  manner :  Rub  the  part  with  snow  or  immerse  it 
in  iced  water,  the  patient  during  the  procedure  being 
kept  in  a  cool  room,  avoid  even  the  warmth  of  the 
bed,  which  has  been  known  to  set  up  inflammation 
w^ith  a  tendency'  to  run  on  to  gangrene.  As  soon  as 
the  bodily  temperature  and  that  of  the  part  in- 
volved has  be  come  about  normal,  stimulating  fric- 
tion should  be  applied  with  Soap  Liniment,  Alcohol 
diluted  with  water  or  Spts.  Camphor.     (A.) 

Immediate  Application  of  \Varmth  : — The  immer- 
sion of  the  affected  part  in  a  hot  bath  at  once  is  ad- 
vocated by  Shoemaker.  This  is  contrary  to  general 
usage. 

The  following  are  recommended  for  application 
after  reaction  has  set  in;  the  parts  should  after- 
^'ards  be  well  enveloped  in  cotton : 

Tr,  Benzoin  Comp,: — Alone  or  in  combination 
with  Chloroform,  3  parts  to  1,  painted  on,  acts  well. 
(Sh.) 

Nitrate  of  Silver: — Gr.  v-^j,  applied  with  a  brush. 
(W.  C.) 

Cocaine  Hydrochlorate  : — 1  to  10  per  cent,  in  Pep- 
permint Water,  useful  for  allaying  irritation  and 
itching.     (Sh.) 

Aluminum  Acetico-Tartaricum : — A  50  per  cent, 
solution  is  astringent,  antiseptic  and  non-toxic.  (Sm. ) 

Alcohol: — In  the  follovring  may  be  applied  wnth 
old  linen: 


(F.) 


ft.    Alcoholis, 

3ij- 

Cocainae  Hydrochloratis, 

gr.  V 

Acid.  Borici, 

5J- 

M. 

COLD,    EFFECTS   OF.  153 

Ung.  Acid.  Carbolici: — Gr,  xx— .|j,  useful  for  painful 
ulcerations  of  the  fingers  and  toes.  It  relieves  pain 
promptly  and  promotes  resolution.     (Al.) 

Thiol: — In  the  form  of  a  powder,  viz.: 

9;.    Thioli  Siccae,  3j. 

Zinci  Oxidi,  3*3- 

Amyli,  gj. 

Talci,  gij. 

M. 

Or  in  an  ointment, 

9;.    Thioli, 

Vaselini,  aa  3J. 

Lanolini,  ^j. 

M.  (Al.) 

Acetanilid : — When  the  parts  are  raw  and  exposed, 
an  ointment  may  be  ordered.     (Sj.) 

Phulluah : — This  drug  is  largely  used  as  a  liniment 
among  the  Hill  tribes  of  India;  it  is  a  stimulant, 
emollient,  anodyne,  and  antiseptic.     (F.) 

Ichthyol: — Has  been  found  effective;  may  be  used 
with  lanolin  in  the  proportion  of  2  drachms  to  6  oz. 
(W.  C.)    See  also  Chilblain. 

GENERAL  DEPRESSION  FROM  COLD. 

Treatment  must  be  regulated  by  the  degree  of  de- 
pression. While  a  fair  pulse  and  consciousness  re- 
main, warmth  should  be  applied  very  cautiously  and 
gradually.  But  if  there  be  apparent  death  from  cold, 
and  the  patient's  limbs  are  rigid,  he  should  be  cov- 
ered with  snow  to  the  depth  of  several  inches,  his 
mouth  and  nostrils  only  being  left  free.  The  melted 
snow^  should  be  replaced  by  fresh.  If  no  snow  be 
available,  an  iced  salt  bath  for  a  few  minutes  may 
bring  reaction.    Where  the  limbs  are  less  rigid,  the 


154  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

clothing  should  be  removed  and  the  whole  surface  of 
the  body  briskly  rubbed  with  snow  or  iced  water 
until  the  pallor  of  the  skin  yields  to  redness.  The 
rubbing  should  then  be  continued  v^dth  dry  flannels, 
and  presently  the  patient  maj^  be  wrapped  in  a  dry 
blanket  and  placed  in  a  cool  bed  in  a  cool  room.  In- 
jections of  tepid  camphorated  water  will  promote 
revival,  and,  as  soon  as  the  patient  can  sw^allow, 
camphor  should  be  administered.  Ultimately  warmth 
may  be  very  gradually  applied.  In  cases  of  suspended 
breathing,  artificial  respiration  should  be  resorted 
to.     (Rd.,  A.) 


COLIC. 

Heat: — This  agent  in  some  of  the  following  forms 
is  generally  effective :  hot  water  bags  or  bottles,  hot 
plates,  hot  fomentations,  mustard  poultices,  etc. 

Enema : — A  copious  injection  of  warm  w^ater  w^ill 
often  relieve  intestinal  colic.     (Rd.) 

Turpentine  Stupes: — Have  been  used  with  good 
effect.  (F.)  Hot  Baths: — These  are  especially  ser- 
viceable in  renal  and  hepatic  colic.  Morphia; — Sub- 
cutaneous injections  are  usually  necessary  in  renal 
and  hepatic  forms.  Chloroform : — Inferior  to  mor- 
phia but  superior  to  baths  or  opium.     (R.) 


COLLAPSE. 

See  Shock. 


COMA.  155 


COMA. 

Oxygen  Inhalations :— Indicated  when  narcotic 
poisoning  is  the  cause ;  if  persistently  employed,  life 
may  be  saved. 

Cold  Douche : — For  stupor  of  drunkenness  and 
also  for  narcotic  coma,  should  be  kept  up  for  some 
time  if  pulse  and  breathing  continue  good  or  become 
no  worse.     (Rd.) 

Blisters  and  Sinapisms: — Applied  in  quick  succes- 
sion to  the  chest,  abdomen,  thighs,  and  calves,  are 
valuable  in  critical  conditions  near  the  end  of  an 
acute  illness,  "only  such  cases  to  be  selected  as  are 
to  be  tided  over  a  dangerous  point."  (F.)  Blisters 
to  back  of  the  neck.     ( Bt. ) 

Coma  due  to  affections  of  the  brain  and  menin- 
ges: 

The  following  methods  of  treatment  are  appli- 
cable : 

1.  Place  the  patient  in  a  well  aired  room. 

2.  Massage  entire  body  with  alcohol  and  water. 

3.  Apply  sinapisms  to  the  legs. 

4.  Apply  four  leeches  to  the  mastoid  process  or 
bleed  from  the  arm. 

5.  Give  an  enema  of  the  following : 

9(.    Sodii  Sulphatis,  ^j. 

Sennae  rolii,  g  ss. 

Aquae,  ad  |viij. 
M.     Ft.  Infusion. 

6.  Practice  rhythmical  tractions  of  the  tongue  by 
the  method  of  Laborde. 


156    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

7.  If  deglutition  is  too  difficult  to  take  food,  give 
this  enema : 

Yolk  of  Eggs,  lo. 

Peptone,  Dry,  4  drachms. 

Milk,  8  ounces. 

(T.,  97.) 
Chapman's  Method  of  Ice  to  the  Spine: — This  may 
be  employed  eflfectively  in  apoplectic  coma;  for  the 
technique  and  indications  see  the  subject  under  the 
head  of  Paralysis. 

Coma  of  infectious  toxic  origin  : 

(1)  Give  subcutaneously  every  hour  an  injection  of 
Ether  or  Caffein,  viz.: 

9;.    Caffeinse,  gr.  xlv. 

Sod.  Benzoatis,  5J- 

Aq.  BuUientis,  5"j- 

M. 

Sig.     Dose,  M.x. 

(2)  Every  four  hours  a  tablespoonfal  by  the  mouth 
of  the  following :  * 

^.    Ammon.  Acetat.,  3J- 

Tr.  Moschi,  gr.  xv. 

Ess.  Menth.  Pip.,  M.iv. 

Tr.  Jalap.,  gjss. 

Tr.  Gentian.,  q.  s.  ad  5j- 
M. 

(3)  Copious  injections  of  cold  water,  lYz  qts.  to 
provoke  diuresis. 

Coma  of  neurotic  origin  : 
The  following  enema : 

Tr.  Valerian,  5Jss. 

Musk,  gr.  XV. 

Yolk  of  Egg,  I. 

Water, ^ 

*NoTE. — The  above  formula,  though   outside  the  province  oi 
this  book,  has  been,  given  to  complete  the  method  quoted. 


COMEDO.  157 

Compress  the  carotid  arteries,  practice  rhythmati- 
cal  contraction  of  tongue  and  pass  the  interrupted 
current  through  different  parts  of  the  bod3^  (T.,  97.) 

DIABETIC  COMA. 

SaHne  transfusions  and  intravenous  injections  of 
soda  bicarbonate  solutions  have  been  administered 
with  brilHant  but  temporary  effect. 

Normal  Saline  Solution : — In  cases  of  coma  this 
fluid  has  been  injected  in  quantities  of  about  2^ 
pints.     (P.  M.,  6,  99.) 

Solution  of  Soda  Bicarbonate : — 2  litres  of  steril- 
ized w^ater  containing  20  grains  of  the  bicarbonate 
of  soda  have  been  followed  by  improvement  in  im- 
pending coma.     (L.  M.,  6,  31,  99.) 

Lepine  recommends  the  following  solution  for 
intravenous  injection : 

Sodium  Chloride,  i  drachm. 

Sodium  Bicarbonate,  2^  drachms. 

Distilled  Water,  i  quart. 

(P.  M.  J.,  4,  29,  99.) 

UREMIC  COMA.     See  Uraemic  Poisoning. 


COMEDO. 

Compare  Acne  Simplex. 

Wash  the  parts  freely  with  warm  water  and  soap 
before  attempting  extraction.  The  individual  comedo 
should  be  squeezed  out  with  the  fingers  protected 
w^ith  a  handkerchief;  care  must  be  taken  not  to 
bruise  the  skin ;  after  extraction  one  of  the  following 
mav  be  used : 


158  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Sulphur  Sublimate : — 2  drachms  with  alcohol  1 
ounce.  Apply  night  and  morning  and  allow  to  re- 
main on.     (Kp.) 

Salicylic  Acid: — An  alcoholic  solution,  gr.  xv-§j, 
w^ill  soften  and  aid  in  their  removal.    (Al.) 

Friction:  —  Rubbing  the  skin  with  green  or  soft 
soap  and  water  is  excellent.  Avoid  over-stimula- 
tion.    (Ja.) 

The  following  is  useful ;  it  should  be  rubbed  on  at 
night  with  a  piece  of  flannel : 

^.    Saponis  Olivae  Prseparatse, 

Alcoholis,  aa  Jj. 

Aq.  Rosae,  ^vj. 

M.  (Ja.) 

Resorcin : — As  a  lotion  or  ointment.     (B.  H.) 
Zinc  Oleate : — With  3  per  cent,  of  salicA^ic  acid  or 
French  chalk .     ( Sm . ) 
Thymol: — As  an  ointment,  viz.: 

9;.    Thymoli,  gr.  x. 

Acid.  Borici,  ^ij. 

Tr.  Hamamelidis  Virg. ,  gj. 

Aq.  Rosse,  5^^. 
Sig.     Apply  once  or  twice  a  day.  (Sh.) 

Medicated  soaps  can  be  used  to  advantage ;  those 
containing  Sulphur,  Chamomile,  Ergot,  Salicylic 
Acid,  or  Corrosive  Sublimate  should  be  preferred. 


CONDYLOMATA. 

Immediate  removal  w^ith  the  scissors  and  cauteri- 
zation of  the  base  with  Nitric  or  Carbolic  Acid  may 
be  practiced  in  the  pedunculated  variety.  Broad 
growths  should  be  first  cocainized,  then  nitric  acid 


CONDYLOMATA.  159 

applied.  After  removal  and  cauterization,  use  some 
of  the  antiseptic  dusting  powders,  such  as  Dermatol, 
Iodoform,  Bismuth  Subnitrate,  etc. 

Calomel: — Dusted  on  with  the  use  of  moderate 
pressure  is  l3est  for  condylomata  with  broad  flat 
base,  especially  when  they  are  numerous.  (CI.)  The 
parts  should  first  be  washed  with  chlorinated  soda. 

Tr.  Thuja : — For  use  when  the  growths  are  situ- 
ated on  the  glans  penis  or  scrotum  accompanying 
gonorrhoea.  (Hg.) 

Labarraque's  Solution: — Diluted,  recommended  for 
warts  around  the  labia,  followed  by  calomel,  resor- 
cin,  or  burnt  alum  and  savine,  equal  parts  of  each. 
(B.H.) 

Hydrarg.  Bichlorid.: — One  of  the  best  remedies. 
Bathe  the  part  with  a  1-2000  solution  and  dust  on 
the  following  powder:  powdered  savine  and  pow- 
dered salicylic  acid,  equal  parts.  (Vn.)  A  solution 
of  30  grains  in  collodion  applied  with  a  brush  will 
often  prove  eifective.     (Cltn.) 

Salicylic  Acid: — In  combination  with  collodion  in 
a  saturated  solution  may  be  painted  on.     (Cltn.) 

Acetic  Acid: — 1  ounce,  with  salicylic  acid,  half  a 
drachm,  is  a  combination  preferred  by  Unna;  the 
mixture  is  applied  twice  daily  with  a  camel's  hair 
brush.     (F.) 

Chromic  Acid  : — 5  drachms  w^ith  1  ounce  of  w^ater 
forms  an  efficacious  caustic ;  surrounding  parts  must 
be  well  protected.     (B.) 

Calomel  and  Salicylic  Acid: — Equal  parts  form  an 
especially  effective  pow^der.     (Cltn.) 

Caustic  Lead: — Lead  oxide,  4  grains  mixed  with  2 
drachms  of  a  saturated  solution  of  caustic  potash 
(100°),  forms    a    caustic    which    produces    a  black 


160  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

slough,  but  does  not  penetrate  deeply.  (N.)  Contact 
■with  the  growth  for  five  minutes  will  soften  the 
mass  and  permit  easy  removal,  after  which  apply  an 
antiseptic  dusting  powder. 

Nitric  Acid: — In  addition  to  its  action  as  a  cauter- 
ant,  may  be  used  in  an  aqueous  solution,  sj-Oj,  for 
bathing  the  affected  surfaces.  Under  its  influence  the 
growth  will  disappear.     (B.) 

Euphoren: — An  excellent  dusting  powder.     (Sh.) 


CONJUNCTIVA,  BLENORRHCEA   OF. 

Keep  the  patient  quiet,  allowing  him  to  go  into  the 
open  air  only  at  stated  intervals.  Strictly  quaran- 
tine, and  observe  great  caution  in  regard  to  cleanli- 
ness and  the  prevention  of  contagion.     (Ro.) 

Iced  Cloths: — These  should  be  applied  to  the  closed 
lids  while  in  the  recumbent  position  for  fifteen  or 
tw^enty  minutes  continuousl3',  every  one,  two  or 
three  hours,  according  to  indications.  (Ro.)  They 
are  also  advised  to  be  kept  applied  continuously  as 
long  as  there  is  marked  oedema  of  the  lids  and  con- 
junctiva. 

Nitrate  of  Silver : — A  solution  of  gr.  v— xx— ^, 
should  be  applied  to  the  palpebral  conjunctiva  once 
or  twice  a  day  by  the  surgeon  while  the  nurse  may 
use  alum,  gr.  ij-5J.  (Ro.)  Strong  solutions  of  the 
nitrate  of  silver  should  be  neutralized  by  salt  solu- 
tions.    (Bl.) 

Cocaine  Hydrochlorate: — A  solution  of  gr.  viij-|j 
should  be  dropped  into  the  eye  according  to  circum- 
stances for  the  relief  of  pain  when  the  iced  cloths  fail 


CONJUNCTIVITIS.  161 

to  relieve.  When  using  this  remedy  the  eye  should  be 
flooded  with  it,  using  10  to  30  drops.     (Ro.) 

Alum  Crystal : — As  the  swelling  of  the  lids  and 
other  symptoms  subside,  this  ma\'  replace  the  iced 
cloths  and  nitrate  of  silver ;  the  lids  are  inverted  and 
the  alum  applied  bj^  the  surgeon.     (Ro.) 

Benzoated  Lard  or  Vaseline  should  be  smeared  on 
the  lids  at  all  stages  of  the  disease  after  applications. 
(Ro.) 

The  absorbent  cotton  and  old  linen  used  in  making 
applications,  and  cleansing  the  eye,  should  all  be 
burned  and  the  patient's  clothing  washed  apart 
from  others. 


CONJUNCTIVITIS,  ACUTE  CATAR- 
RHAL. 

Boric  Acid : — According  to  Noyes  a  1  per  cent, 
solution  is  the  best  local  remedy.  The  following 
also  have  proved  useful : 

9;.    Acid.  Borici, 

Sod.  Biboratis,  aa  gr.  x. 

Aq.  Destill.,  3j. 

M. 

Or, 

9^.    Acid.  Borici,  gr.  vj. 

Aq.  Camphorae, 

Aq.  Destill.,  aa  Jj. 

M.  (Bl.) 

Cocaine   Hydrochlorate: — A  2  per  cent,   solution 
may  be  dropped  into  the  eye  at  intervals  of  ten  min- 
utes until  sensitiveness  is  allayed.     This  is  recom- 
12 


162    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

mended  when  there  is  much  discomfort  from  heat^ 
grittiness  and  smarting.  Since  the  remedy  has  the 
propert3'  of  causing  the  blood  vessels  to  contract, 
it  is  useful.     (Ny.) 

Zinc  Sulphate:  —  1  to  2  grains  to  the  ounce  of 
water  is  of  service.    ( Ro. ) 

When  the  inflammation  is  of  traumatic  origin 
Bo3de  recommends  the  following : 

^.    Tr.  Aconiti,  gtt.  x. 

Aq.  Destill.,  3J. 

M. 

Or, 

^.    Tr.  Amicae,  gtt.  x. 

Aq.  Destill.,  3j. 

M. 

Or, 

T^.    Tr.  Hamamelidis, 

Tr.  Arnicse,  aa  gtt.  x. 

Aq.  Destill.,  3j. 

M. 

Tr.  Ledum : — When  there  is  much  ecchymosis  10 
drops  to  the  ounce  of  water.     (Bl.) 

Alum : — Solution  of  gr.  j-ij-5J  •  ( Ro. )  This  remedy 
is  condemned  by  some  oculists  as  injurious.     (Ny.) 

Cold  Cream  or  simple  Cerate  applied  to  the  lids 
is  of  service.  Many  cases  require  no  other  treatment 
than  the  boric  acid  and  borax  prescription  above. 

If  the  inflammation  is  more  severe  the  following 
w^ill  prove  useful:  Lead  Acetate: — 1  drachm  with 
infus.  of  opium,  1  pint.  This  should  never  be  used 
w^hen  there  is  any  tendency  to  ulceration  of  the 
cornea,  as  it  forms  a  precipitate  on  it.  It  is  only 
useful  in  the  early  stages  and  must  be  applied  warm. 


CONJUNCTIVITIS   GRANULOSA.  163 

Liq.  Plumb.  Subacetatis: — 2  drachms  to  water  6 
ounces,  is  also  employed.  Nitrate  of  Silver : — Gr.  ij- 
,^j,  dropped  into  the  eye  may  be  used  daily  when 
there  is  a  large  quantity  of  secretion  or  intense  red- 
ness or  eifusion  which  calls  for  active  interference. 
Tannin: — Gr.  v-.^j,  suitable  when  oedematous  infil- 
tration is  extensive  and  secretion  moderate.  It  is 
sometimes  also  useful  in  old  people.     (Ny.) 

Formalin,  1-2000  and  Bichloride  of  Mercury, 
1-10000,  are  used  as  an  antiseptic  lotions.    (Bl.) 

Hydrarg.  Oxid.  Flav.:  —  Gr.  ss-3j,  answers  well 
when  there  are  incrustations  on  the  eyelids.  Apply 
only  at  the  root  of  the  cilia,  and  do  not  allow  any  to 
enter  the  eye.     (F.) 

Cleanliness  is  in  all  cases  of  the  utmost  import- 
ance. After  subsidence  of  the  symptoms  examine  for 
hypermetropia  and  astigmatism. 


CONJUNCTIVITIS  GRANULOSA. 

See  Trachoma. 


CONJUNCTIVITIS,   CHRONIC 
CATARRHAL. 

Alum : — 1  to  2  grains  with  10  grains  of  Boric  Acid 
is  very  useful  in  many  cases.  A  little  Morphine  may 
sometimes  be  added. 

Nitrate  of  Silver: — Gr.  ss-^j.  Its  long-continued 
use  will  cause  an  unsightly  and  irremovable  stain; 
in  strong  solution,  it  may  cause  permanent  opacity 


164  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

of  the  cornea.  It  is  nevertheless  an  old  and  well 
used  remedy. 

Tannin: — Gr.  ij-v-5j.  A  few  drops  in  the  eye;  or 
evert  eyelid  and  paint  with  a  solution  of  gr.  x-xxx-^j. 

Zinc  Sulphate: — Extensively  emplo^'ed,  gr.  ss-ij-gj. 
The  solution  maj^  be  applied  two  or  three  times  a 
day. 

\A^ine  of  Opium: — A  drop  in  the  e^-e  relieves  pain 
and  improves  condition  of  the  membrane.     (Al.) 


CONJUNCTIVITIS,  DIPHTHERITIC. 

Atropia  or  Scopolamine: — To  be  used  from  the 
start.     (Ro.) 

Papoyotin : — 1  part  v^ith  5  or  10  parts  of  water 
and  gh'cerine  (not  to  be  substituted  Ija'  papoid)  may 
be  applied  everj' hour.     (Jac.) 

Ice  and  Cold  Applications : — Authorities  differ.  Ice 
should  be  persistently  applied,  according  to  Jacobi. 
On  the  other  hand,  MacBride  says  cold  applications 
should  not  be  made  to  any  great  extent  because  it 
interferes  with  the  nourishment  of  the  cornea. 
Roosa  says  hot  or  cold  applications  to  the  closed 
lids  as  may  be  most  comfortable.  Great  care  should 
be  exercised  in  cleansing  the  eye,  as  the  slightest 
abrasion  of  the  cornea  w^ill  allow  the  membrane  to 
form  on  the  denuded  surface. 

Hydrogen  Peroxide: — 3  per  cent,  solution  recom- 
mended for  cleansing;  too  strong  solutions  cause 
haziness  of  cornea.  The  secretions  should  be  re- 
moved every  night  with  cotton  dipped  in  a  saturated 
solution  of  boric  acid,  and  an  ointment  applied  to 
the  edges  of  the  lids.     (Ro.) 


CONJUNCTIVITIS,  PHLYCTENULAR,  165 

Antitoxine  Serum  is  reported  to  have  been  used 
W'ith  success.     (T.,  96.) 


CONJUNCTIVITIS,  PHLYCTENULAR. 

Atrophia  Sulphate: — Instillations  of  a  solution  of 
gr.  ss— ij— 5J,  should  be  made  two  or  three  times  a 
day.     (Ro.) 

Cold  Douche: — If  there  is  much  photophobia  this 
is  very  useful ;  it  is  often  of  immediate  service,  but  is 
a  harsh  remedy.  Cocaine  may  be  substituted,  but  if 
not  effectual,  the  douche  should  be  employed.     (Ro.) 

Glycerate  of  Tannin : — Very  useful  for  application 
to  the  nostrils  for  the  catarrh  which  is  usually  pres- 
ent.    (Ro.) 

Calomel  :*— By  insufflation  or  dusted  on  with  a  fine 
camel's  hair  brush  is  a  very  valuable  application ;  it 
should  not  be  employed  when  there  is  much  ciliary 
irritation,  as  shown  by  photophobia,  lachrymation, 
or  contracted  pupil ;  these  should  first  be  controlled 
by  atropine.     (Al.) 

Cocaine : — Should  be  used  until  the  acute  symp- 
toms, especiallv  the  photophobia,  have  disappeared, 
(Ro.) 

Ung.  Hydrarg.  Oxid.  Flav.: — Has  been  used  suc- 
cessfully instead  of  calomel.  A  small  portion  is 
placed  between  the  eyelids  and  rubbed  on.     (Ro.) 

Bismuth  Loretinate: — Dusted  in  the  eye  promptly 
relieves,     (T,,  97,) 

*  Note. — Before  applying  calomel  to  the  eye  first  inquire  if  the 
patient  has  been  on  a  course  of  iodides,  for  a  chemical  combination 
may  follow  which  may  cause  great  disturbance. 


166         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Pyoktanin: — A  solution  of  1—1000  acts  best  in 
cases  marked  b^^  lachrymation  and  great  congestion 
of  the  palpebral  conjunctiva.  Ichthyol : — 1  to  3  per 
cent,  solution  has  been  found  very  useful.  Antipy- 
rin: — 2  per  cent,  solution.     (T.,  98.) 


CONJUNCTIVITIS,   PURULENT. 

In  the  earlier  stages  mild  antiseptic  lotions  and 
bathing  the  eye  in  hot  water  are  indicated,  but  it  is 
usually  not  until  after  this  period  that  the  patient  is 
seen  by  the  surgeon.  (N.  O.)  When  the  stage  of 
secretion  has  set  in,  the  following  remedies  will  be 
indicated : 

Nitrate  of  Silver: — This  remedy  has  more  power 
than  any  other  in  neutralizing  the  poison.  When  the 
secretion  and  swelling  are  slight,  solutions  of  2  to  5 
grains  to  the  ounce  may  be  used ;  but  when  there  is 
much  swelling  and  secretion,  the  strength  should 
vary  from  10  to  even  60  grains  to  the  ounce  in  very 
severe  forms.  The  solution  is  to  .be  applied  to  the 
everted  lid  with  a  brush  and  the  cornea  protected  at 
the  time  of  application.  Salt  solutions  must  be 
added  immediately  to  neutralize.  (Bl.)  These  solu- 
tions should  be  followed  at  once  by  ice  cold  applica- 
tions in  order  to  prevent  reaction.     (N.  O.) 

Formalin :— 1-1000  or  2000  must  be  used  freely 
for  bathing  the  eye.  Hydrarg.  Bichlorid.: — 1-4000, 
1-5000  or  10,000.  Boric  Acid :— Saturated  solu- 
tions, for  cleansing.     (Bl.) 

Potass.  Permang.: — Gr,  iij-x— 5J,  has  been  highly 
recommended ;  it  should  be  applied  thoroughly  to 


CONJUNCTIVITIS,   PURULENT.  167 

the  conjunctiva  twice  a  day  in  severe  cases  and  once 
a  day  in  mild.     (N.  O.) 

Ice  Cold  Applications : — Placed  upon  the  lids  are 
of  great  value  in  checking  the  inflammation.  They 
should  be  kept  continuously  applied,  being  changed 
as  soon  as  warm,  which  will  be  in  a  minute  or  two. 
(N.O.) 

The  following  is  a  summary  of  treatment  recom- 
mended by  Roosa : 

Early  Stages. 

1.  Cleanse  the  conjunctival  sac  as  often  as  the  dis- 
charge collects,  night  and  day,  with  absorbent  cot- 
ton, saturated  solution  of  Boric  Acid  or  Borax  in 
water.  2.  Cold  applications  by  Iced  Cloths  unless 
there  is  ulceration  of  the  cornea.  3.  Free  use  of 
Vaselihe  to  lids  and  surroundings. 

Later  Stages. 

1.  Daily  application  of  Nitrate  of  Silver  gr.  v-x- 
gj,  or  every  two  hours  application  of  a  solution  of 
4^^  grain  to  the  ounce  in  the  form  of  spray  until  the 
epithelium  of  the  cornea  is  coated.  2.  The  dropping 
into  the  eye  of  Antiseptics  by  an  attendant. 

Atropine : — Indicated  if  the  cornea  shows  signs^  of 
becoming  involved.     (Ro.) 

When  only  one  eye  is  affected  the  other  should  be 
hermetically  sealed  by  the  Buller  shield  or  some  other 
such  device.  Prophylaxis  from  contagion,  and  isola- 
tion of  patient  when  possible  should  be  strictly  en- 
forced.    (N.  O.) 


168         DIGEST  OF  EXTERNAL  THERAPEUTICS. 


CONSTIPATION. 

It  should  be  the  rule  to  go  to  the  closet  at  a  defi- 
nite and  regular  hour  each  day  irrespective  of  in- 
clination ;  the  best  time  is  immediately  after  break- 
fast, as  intestinal  peristalsis  has  already  been 
induced  hj  that  meal.  Long  continued  and  ineffect- 
ual straining  should  be  avoided.  Persons  of  sedent- 
ary habits  should  take  regular  exercise,  especially 
outdoors,  riding,  bicycling,  tennis  and  other  sports. 

Hydrotherapy : — The  cold  spinal  douche  adminis- 
tered while  the  patient  is  in  a  hot  bath,  or  the  alter- 
nate application  of  hot  and  cold  water.  When  there 
is  spasm,  sedative  applications,  as  flannels  wrung 
out  in  hot  w^ater,  placed  over  the  abdomen  at  night 
and  covered  with  oiled  silk.  (M.  N.,  12,  10,  98.) 
Cold  sitz  baths  in  the  morning  are  also  beneficial. 
(Rd.) 

Massage: — General  or  to  the  abdomen;  percussion, 
and  pounding  the  abdomen  with  the  inner  border  of 
the  fists  in  the  direction  of  the  ascending  and  de- 
scending colon  are  effective  in  some  cases.     (Sj.) 

When  the  abdominal  w^alls  are  flaccid  and  the  in- 
testines atonic,  a  moderately  firm  bandage  will  be 
of  benefit,  but  exercise  of  the  abdominal  muscles  is 
much  better ;  this  maj'  be  performed  by  forcibly  and 
rapidly  retracting  the  abdominal  muscles,  repeating 
the  movements  several  times  a  day.     (Gn.) 

Oil  Injections : — From  6  to  8  ounces  are  injected 
w^hile  the  patient  is  lying  on  the  left  side  with  the 
hips  elevated ;  then  he  lies  upon  the  back  and  finally 
on  the  left  side.    The  results  are  not  immediate,  but 


CONSTIPATION.  169 

the  effect  will  persist  for  three  or  four  days.  (M.  N., 
12,  10,  98.) 

Glycerine: — Injections  of  a  drachm  or  two ;  or  giy- 
cerine  suppositories  are  useful. 

Gluten  Suppositories  : — In  mild  cases  and  for  chil- 
dren.    (Gn.) 

Enemata  : — When  it  is  not  expedient  to  give  a  ca- 
thartic, injections  of  Castile  soap  and  water  with 
olive  oil  may  be  used,  especially  if  there  are  hardened 
masses  of  faecal  matter.  For  an  immediate  effect  the 
following  may  be  injected  into  the  rectum : 


Sulphate  of  Magnesia, 

gij- 

Glycerine, 

iij- 

Turpentine, 

§ss. 

Wami  Water, 

,?iv. 

ject  the  entire  quantity,  and 

a  movement  will 

soon 

follow. 

This  is  valuable  in  abdominal  surgery  for  empty- 
ing the  bowels  before  operating.  In  cases  of  arterio- 
sclerosis and  high  vascular  tension  it  will  reduce  the 
latter  and  relieve  distressing  symptoms.     (Gn.) 

Electricity  : — Galvanism ;  an  insulated  rectal  elec- 
trode is  attached  to  the  negative  pole  and  inserted 
into  the  rectum,  the  positive  electrode,  which  should 
be  flat  and  large,  is  placed  over  the  abdomen.  A 
moderate  current,  not  sufficient  to  produce  discom- 
fort, is  then  applied.  It  is  very  important  that  the 
rectal  tube  should  be  insulated;  it  should  also  be 
hollow  so  that  from  four  to  eight  ounces  of  w^ater 
may  be  thrown  into  the  rectum.  The  applications 
should  be  repeated  daily  or  every  other  daA'.    (Gn.) 


170         DIGEST    OF   EXTERNAL   THERAPEUTICS. 


CONTUSIONS. 

Rest  to  the  part  is  important;  this  may  best  be 
secured  b^^  placing  the  patient  in  bed,  by  Splints, 
Plaster  of  Paris  or  Bandages,  according  to  the 
nature  and  location  of  the  injury.  Contusions  of  the 
back  may  be  advantageously  treated  by  the  applica- 
tion of  Rubber  Adhesive  Plaster  cut  in  strips  tv^o 
and  one-half  inches  wide  and  long  enough  to  extend 
well  beyond  the  contusion.  The  plaster  should  be 
placed  so  as  to  run  in  different  directions.     (W.  C.) 

The  following  are  some  of  the  numerous  lotions 
recommended  for  bruises : 

Arnica: — Widely'  employed.  The  tincture  may  be 
diluted  with  water,  1  part  to  10,  and  saturated  com- 
presses applied  covered  Avith  oiled  silk. 

Hamamelis: — Instead  of  arnica,  especially  w^hen 
there  is  much  ecchymosis  and  the  skin  is  broken,  1 
part  to  6  of  water.     (Rd.) 

Lead  and  Opium : — A  combination  long  in  use  and 
of  established  merit,  viz.: 


9(.    Tr.  Opii, 

Liq.  Plunibi  Subacetat.  Dilut., 

aa  gj-ij. 

Aq.  Destill., 

adOj. 

M. 

Apply  with  saturated  compresses  and  cover  with 
oiled  silk  and  bandage.     (Whar.) 

5fc.    Alcohol.  Dilut.,  |iij. 

Liq.  Plumbi  Subacetat.  Dilut.,  ^j. 

Morph.  Acetat.,  gr.  x. 
M. 


CONTUSIONS.  171 

Apply  on  a  la^^er  of  lint  and  allow  to  evaporate ; 
this  is  excellent  for  keeping  down  inflammation. 
<Sm.) 

Opium : — The  tincture  with  Lin.  Saponis,  a  drachm 
to  the  ounce,  rubbed  in  once  or  twice  a  day,     (Wa.) 

Lead: — As  Goulard's  cerate  or  the  carbonate,  viz.: 


Plumbi  Carbonatis, 

Jss. 

Creosoti, 

M.x. 

Ol.  Olivte, 

q.  s. 

M.  (Sm.) 

Hazeline: — An  excellent  preparation  made  of  the 
v^dtch  hazel  twigs  as  an  embrocation.     (Sm.) 

Calendula : — 1  part  of  the  succus  with  about  5  of 
carbolized  or  sterilized  water,  when  there  is  lacera- 
tion together  wath  contusions.     (M.  H.) 

Capsicum: — A  strong  tincture  mixed  wdth  gum 
gives  excellent  results  in  removing  discoloration  of 
the  skin.     (R.)     The  following  also  recommended : 

9r.    Tr.  Capsici, 

Tr.  Myrrhae, 

Tr.  Opii,  aa,  gij. 

Tr.  Guaiac,  3J. 

Spts.  Camphor.,  ^ij. 

M.  (Sn.) 

Aqua  Sedativa : — Maj^  be  applied  to  painful  parts 
on  saturated  compresses,  without  friction.     (N. ) 

Ammonium  Chloride  : — For  contusions  of  the  face 
w^ith  much  ecchymosis,  Agnew  recommended  a  solu- 
tion in  the  proportion  of  5  grains  of  the  chloride  to 
half  an  ounce  each  of  alcohol  and  water.  A  simple 
lotion  of  5  grains  to  the  ounce  may  be  employed. 
Stronger  solutions  also  are  used  as  ^ij-iv-Oj.    (Sm.) 

A  good  formula  is  as  follows : 


172  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


Ammon.  Chloridi, 

gr. 

Tr.  Opii, 

Alcoholis, 

aa  3j. 

Aquae, 

q.  s.  ad  gj. 

M. 

Several  layers  of  lint  are  saturated,  applied  over 
the  contused  tissues  and  then  covered  with  oiled  silk 
or  rubber.     (Whar.) 

Ruta : — 10  drops  of  the  mother  tincture  to  w^ater, 
1  ounce,  may  be  employed  as  a  lotion  in  place  of 
arnica,  vv^hen  the  latter  has  a  tendency  to  produce 
erysipelas,  and  when  the  contusion  is  more  of  the 
bone  than  of  the  soft  parts.     (Rd.) 

Ichthyol : — Pure  or  with  equal  parts  of  water  gives 
good  results.     (Al.) 

Cold  ^A^ater: — Bathing  the  parts  in  cold  w^ater  fol- 
low^ed  by  cold  compresses.  (Rd.)  Hot  ^A(''ater : — In- 
stead of  cold  affords  great  relief  to  pain  and  reduces 
sw^elling. 

Liniments: — Several  are  of  service  and  are  much 
used  for  relieving  the  pain  of  contusions  especially 
when  associated  v^ith  sprains,  viz.: 

Lin.  Chloroform!,  (tr.  aconiti,  chloroformi,  aa  |ss, 
lin.  saponis,  |j.)  A  piece  of  linen  or  flannel  saturated 
v^ith  the  mixture  may  be  applied  to  the  painful  part 
and  covered  with  oiled  silk  to  prevent  evaporation. 
(Al.)  Lin.  Aconiti,  Lin.  Belladonnse,  these  two  are 
best  combined.     Lin.  Camphorae,  Lin.  Saponis.   (N.) 

The  follow^ing  is  suitable  to  sprains  and  bruises 
combined : 

1^.    Aq.  Ammoniae, 
Fid.  Ext.  Amicse, 
Liniment.  Saponis, 
Ol.  Terebinthinae,  partes  equales. 

(Sm.) 


CONVULSIONS.  ]  173 


CONVULSIONS. 

General  Directions : — Place  the  patient  in  the  hori- 
zontal position  in  all  cases,  give  fresh  air,  loosen  the 
clothing,  insert  a  plug  of  cork  or  soft  v^ood  between 
the  teeth  to  prevent  biting  of  tongue,  and  sprinkle 
the  face  v^ith  cold  water. 

EPILEPTIC  CONVULSIONS. 

The  same  general  directions  as  above  will  usually 
be  sufficient. 

HYSTERICAL  CONVULSIONS. 

Same  as  above,  but  no  cork  in  the  mouth  is  neces- 
sary as  there  is  no  w^ounding  of  tongue.  Cold  Effu- 
sions or  Ice  Bags  on  the  head  and  inhalations  of 
Ammonia  or  Camphor.    (B.) 

INFANTILE  CONVULSIONS. 

Hot  Baths: — With  Mustard  are  very  v^idely  em- 
ployed and  generally  recommended.  During  the  bath 
an  ice  bag  should  be  applied  to  the  head.  In  robust 
children,  especially  if  there  is  colic  or  abdominal  dis- 
turbances, these  baths  are  likely  to  prove  of  service, 
but  if  there  is  reason  to  believe  the  convulsions  are 
due  to  cerebral  disease,  or  arise  at  the  end  of  an  ex- 
haustive illness,  they  are  not  advisable  and  may 
prove  injurious. 

Tepid  Baths: — If  the  temperature  is  exceedingly 
high  (105°  to  106°)  it  is  probably  the  exciting  cause ; 
place  the  infant  in  a  tepid  bath  and  pour  cold  water 
on  the  head  and  allow  it  to  run  down  into  the  tub 
and  gradually  lower  the  temperature. 


174  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Ether  or  Amyl  Nitrite: — A  few  drops  by  inhala- 
tion to  calm  the  nervous  system  and  check  the 
violence  of  the  spasms.     (A.  W.) 

Milk  of  Asafoetida: — May  be  used  freely  as  an  in- 
jection. (Sm.)  Leeches  to  the  mastoid  process. 
(T.,  96.) 

Cold  Baths: — A  momentary  immersion  in  an  ice 
cold  bath  followed  by  friction  has  been  found  to  be 
successful  bj^  Anders  in  obstinate  cases,  after  hot 
baths  had  failed. 

Cold  Compresses: — Take  two  folded  handkerchiefs, 
dip  them  in  cold  -water  containing  a  little  vinegar 
and  envelope  the  limbs  as  far  as  the  knees.     (Sj.) 

Enemata: — The  prompt  relief  of  the  bowels  by 
these  means  constitutes  an  important  measure  which 
should  never  be  overlooked. 

Chloral  and  Musk : —  Simon  recommends,  after 
a  w^arm  enema  of  oil,  glycerine  or  salt  has  acted, 
the  following  clyster :  Chloral  8  grains  to  an  infant 
from  3  to  6  months,  11  grains  to  one  9  months,  15 
grains  to  a  child  of  one  year,  with  20  drops  of  tinct- 
ure of  musk,  giving  this  in  three  or  four  parts  to  en- 
sure retention.  (T.,  96.)  The  amount  of  chloral  here 
advised  is  so  largely  in  excess  of  the  usual  dose  that 
caution  is  necessary. 

Chloroform : — One  of  the  most  effective  antispas- 
modics. A  few  drops  may  be  inhaled.  Ruddock  rec- 
ommends 1  part  of  chloroform  with  2  of  olive  oil, 
rubbed  in  over  the  spine  as  a  preventive. 

Convulsions  of  infants  a  few  weeks  old  who  are 
artificially  fed  are  due  in  a  large  majority  of  in- 
stances to  indigestion;  a  w^et  nurse  or  change  of 
food,  therefore,  should  be  procured  at  once.     (A.  W.) 

Besides  irritation  of  the  alimentarv  canal  and  den- 


PUERPERAL  CONVULSIONS.  175 

tition,  bums,  foreign  bodies  in  the  nose  and  ear, 
hernia,  undescended  testicle,  retention  of  urine  or  any 
external  source  of  irritation  should  be  remembered 
as  possible  causes. 

PUERPERAL   CONVULSIONS.     See    also    Ursemic 
Poisoning. 

Induction  of  Labor: — The  weight  of  authority 
tends  towards  immediate  delivery.  In  general  noth- 
ing is  gained  b\^  endeavoring  to  protract  gestation 
and  much  is  lost.  If  dietetics  and  medicinal  meas- 
ures have  failed,  induction  of  labor  should  be  per- 
formed, this  procedure  being  the  best  both  from  the 
standpoint  of  the  mother  and  of  the  child.     (G.  J.) 

When  eclampsia  comes  on  suddenh%  and  when 
urasmic  symptoms  are  increasing,  the  uterus  should 
be  emptied  as  quickly  as  possible. 

During  the  convulsion,  the  following  will  be  found 
of  service  while  waiting  for  the  uterus  to  empty : 

Chloroform: — Will  afford  temporar3'^  relief  only, 
but  time  is  gained  for  other  measures ;  its  utility  un- 
questionable when  there  is  no  cerebral  congestion. 
(B.) 

Morphia : —  Hypodermically  is  a  most  valuable 
agent,  presenting  the  greatest  advantage  and  fewest 
disadvantages.  It  should  be  given  in  large  doses  up 
2y2  grains  in  twenty-four  hours.    (T.,  97.) 

Veratrum  Viride: — Very  highly  praised,  can  be  ad- 
ministered hypodermically ;  twenty-six  cases  with  no 
deaths  treated  thus  and  by  the  mouth,  until  pulse 
dropped  to  60  per  minute,  are  mentioned  bj'  Sajous. 

Amyl  Nitrite: — Inhalations  in  cases  characterized 
b^^  high  arterial  tension  are  of  service.     (B.) 


176  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Glonoine  : — H^^podemiically -^  grain  hourly.  Same 
indications  as  amyl  nitrite.     (G.  J.) 

Pilocarpine  : — H^^podermic  injections  ^  grain  were 
administered  in  four  cases,  in  three  convulsions 
stopped  quickh'  and  permanently ;  it  is  contra-indi- 
cated in  pulmonary  disease.     (Sj.) 

Ice  to  the  head  and  Mustard  to  the  feet  to  relieve 
congestion.     (Wa.) 

Venesection : — When  the  pulse  is  full  and  bound- 
ing and  when  there  is  much  cerebral    congestion. 

Chloral : — 40  grain  doses  by  the  rectum.     (G.  J.) 

UREMIC  CONVULSIONS.    See  Ursemic  Poisoning. 


CORNEA,  OPACITIES  OF. 

Calomel:  —  Dusted  on  every  two  or  three  days, 
prolonging  the  treatment  for  some  weeks,  is  effect- 
ive.    (F.) 

Ung.  Hydrarg.  Oxid.  Flav.: — This  ointment  in  con- 
nection with  massage  has  been  recommended.     (Al.) 

Thiosinamine: — Has  remarkable  effect  in  clearing 
up  corneal  opacities,  but  should  not  be  used  in  cases 
in  v^hich  a  vestige  of  inflammation  is  still  present, 
and  which  might  be  started  up  into  fresh  phh'cten- 
ulae.  The  remedy  is  emplo3^ed  hypodermically,  the 
injection  being  made  deep  into  the  muscular  tissues. 
Alcoholic  and  watery  solutions  are  both  used ;  the 
former  is  painful,  the  latter  less  so  and  apparently  as 
effective.  The  dose  varies  according  to  different  au- 
thorities ;  in  the  beginning  inject  I/2  to  %  grain  twice 
a  week.    Hebra  has  used  as  much  as  4  grains  in  the 


CORNEA,    OPACITIES   OF.  177 

prolonged  use  of  the  remedy ;  it  has  been  found  desir- 
able to  suspend  its  administration  for  ten  days  every 
six  weeks  to  two  months.     (F.) 

Iodine : — 1  to  3  per  cent,  in  vaseline  applied  to  the 
palpebral  conjunctiva  acts  with  promptness  in  su- 
perficial opacities.  When  vision  is  impaired  from  the 
central  position  of  the  opacity,  and  all  treatment  has 
been  unsuccessful,  one  of  the  operations  for  artifical 
pupil  must  be  performed.     (Ro.) 


CORNEA,  ULCERS  OF. 

Galvano-Cautery: — The  serpiginous  variety  are 
best  arrested  by  a  delicate  quick  touch  of  the  cau- 
tery, especially  in  desperate  cases.     (Mac.) 

Atropine: — Solution  of  gr.  iv— §j,  for  adults,  half 
this  strength  for  children;  drops  are  instilled  with 
sufficient  frequency  to  maintain  mydriasis  if  there  is 
a  tendency  to  iritis.     (T.,  97.) 

Eserine: — One-fifth  per  cent,  solution,  1  drop  in  the 
eye  four  times  a  day  to  keep  the  pupil  contracted, 
when  there  is  no  iritis,  for  progressive  ulcers.  (Mac.) 
It  is  indicated  especially  in  peripheral  ulcers  with  a 
tendency  to  perforation  of  the  cornea.     (T.,  97.) 

Hydrarg.  Bichlorid.:— Solution  of  1-2000;  1  drop 
in  the  eye  for  cleanliness.  Brushing  the  ulcer  wath  a 
solution  of  1—1000  will  often  convert  it  into  an 
active  ulcer  and  lead  to  repair.     (Mac.) 

Hydrogen  Peroxide  : — Solutions  of  3  per  cent,  may 
be  employed  in  sloughing  varieties.     (Al.) 

Pyoktanin:— Solutions  of  1-1000  claimed  by  Still- 
ing to  give  satisfactory  results.     Other  authorities 
less  positive. 
13 


178  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Holocaine : — Recent  reports  show  that  this  drug 
has  been  used  with  gratifjang  effects  on  corneal 
ulcers.  In  several  such  cases  ^vhere  improvement 
was  slow  and  relapses  frequent  its  application  was 
followed  by  diminution  of  the  infiltrated  area  and 
later  by  healing  of  the  ulcer.  The  method  of  applica- 
tion was  by  flushing  the  conjunctival  sac  with  a  1 
per  cent,  solution  and  by  touching  the  floor  of  the 
ulcer  with  a  swab  saturated  with  the  same.  (C.  P., 
4,  18,  99.) 

Labarraque's  Solution: — In  the  proportion  of  1 
part  to  7  to  10  parts  of  water  has  been  highly  rec- 
ommended for  sloughing  ulcers ;  in  the  former 
strength  it  may  be  applied  directly  with  pledgets  of 
lint ;  in  the  latter  it  maj^  be  used  as  a  wash.     (Al.) 

Formalin: — A  solution  of  1—2000  when  applied 
freely  acts  well.  Solutions  of  1—1000  painted  on  the 
ulcer  every  two  or  three  hours  retard  the  ulcerative 
process  but  are  very  painful.     (Bl.) 

Protective  Bandage: — This  should  be  generally 
used,  but  is  contra-indicated  when  there  is  consider- 
able discharge  and  in  young  children;  after  corneal 
perforation  employ  a  pressure  bandage. 

Scopolamine  Hydrochlorate  : — Dissolved  in  vase- 
line or  castor  oil,  is  a  useful  m3'driatic  in  superficial 
ulcers.     (T.,  98.) 

Iodine: — Of  great  benefit  in  spreading  ulcers ;  first 
curette  the  ulcer  then  wipe  it  dry  with  a  cotton  cov- 
ered probe  and  apply  iodine  thoroughh^ ;  wash  off 
the  excess  with  a  solution  of  Formaldehyde,  1-2000, 
the  latter  being  also  used  as  a  collyrium  during  the 
treatment.     (T.,  98.) 

Iodoform  or  lodol : — Indicated  in  extending  ulcers 


CORNS.  179 

after  cauterizing  with  the  galvano-cautery,  touch 
only  the  advancing  margin  of  the  lesion  ;  these  reme- 
dies finely  divided  are  useful  for  filling  in  the  ulcer. 
(T.,98.)' 


CORNS. 

Salicylic  Acid: — One  of  the  most  effective  remedies. 
It  may  be  applied  in  the  follov^ing  manner :  Paint 
on  a  saturated  solution  in  collodion,  or  moisten  the 
part  with  some  antiseptic  lotion  and  dust  on  the 
pOAvdered  acid  thickly ;  then  apply  several  layers  of 
borated  lint  and  bind  down  with  gutta  percha  or 
some  convenient  dressing.  This  should  be  left  on 
for  four  or  five  days,  then  renev^ed  if  necessary. 
The  plaster  mull  of  Unna  consisting  of  30  to  50  parts 
of  the  acid  and  5  to  10  parts  of  creosote  spread  on 
gutta  percha  is  another  effective  method.  (F.)  The 
following  applied  once  or  twice  daily  with  a  camel's 
hair  brush  has  been  used  with  great  success : 

9;.    Acid.  Salicylici,  3J- 

Ext.  Cannabis  Indicae,  gr.  x. 

Collodii,  gj. 

M.  (Kp.) 

Vigier's  Preparation  sold  as  "Hebra  Com  Rem- 
edy "  is  similar,  namely  : 

9:.    Acid.  Salicylici,  gr.  xv. 

Ext.  Cannabis  Indicae,  gr.  viij. 

Alcoholis,  M.xv. 

Etheris,  M.xl. 

Colodii  Flex.,  M.lxxx. 
M.  (Ja.) 

Sig.     Paint  on  three  times  a  day  for  a  week.     Then  soak  the 
part  in  hot  water  and  the  corn  can  be  picked  out. 


180  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Tr.  Iodine  or  Tr.  Verat.  Viride  : — Painted  on  is 
useful  for  reducing  inflammation.     (Bt.) 

Calendula : — 20  per  cent,  solution  with  Carbolic, 
1—100,  is  useful  in  allaying  inflammation  arising 
from  injudicious  paring. 

Nitrate  of  Silver: — Applied  in  the  following  man- 
ner is  highlj"-  recommended :  Soak  the  com  in  hot 
w^ater,  then  pare  down  the  horny  layers  and  apply  a 
30  per  cent,  solution.  It  is  claimed  that  the  corn  will 
rarely  reappear.     (F.) 

Copper  Oleate: — Melted  and  spread  on  plaster  wall 
soften.  (Sm.)  Liq.  Potassa  : — For  softening  so  as  to 
permit  removal.  (N.)  Diachylon  Plaster,  Flexible 
Collodion,  Poultices,  Plasters  of  soft  material,  as 
felt  w^ith  a  hole  in  the  centre,  also  useful. 

The  following  are  recommeded  w^hen  a  caustic 
effect  is  desired  (F.): 

Glacial  Acetic  Acid,  applied  by  means  of  a  stick; 
Potass.  Bichromate,  a  saturated  solution;  Sodium 
Ethylate,  applied  with  a  glass  rod;  or  the  combina- 
tion of  Salicylic  Acid  and  Zinc  Chloride,  viz.: 

9:.    Acid.  Salicylici,  3J- 

Zinc.  Chloridi,  3®®- 

Collodii,  5j. 

M.  (F.) 


COUGH. 

Certain  drugs  administered  in  the  form  of  lozenges, 
inhalents  and  cough  mixtures  have  a  topical  effect 
on  the  throat  and  are  sometimes  useful  palliatives. 
Of  these  the  following  are  recommended : 


COUGH.  181 

Acacia : — Forms  the  basis  of  many  pastilles,  and 
in  the  form  of  "gum  drops"  may  allay  a  cough  due 
to  retention  of  mucus  on  the  posterior  nares  or  vocal 
cords. 

Bromide  of  Potash: — 10  to  20  grains  in  an  ounce 
of  water,  used  as  a  spray,  forms  a  good  sedative. 

Chloroform: — A  few  drops  on  a  sponge  or  in  half  a 
pint  of  hot  w^ater  and  the  vapor  inhaled. 

Cubebs: — 10  drops  to  half  an  ounce  of  water,  w^ith 
a  small  quantity  of  magnesia  carbonate  is  sometimes 
used  as  an  inhalant. 

Opium  and  Morphia: — Enter  largely  into  the  for- 
mation of  cough  lozenges,  from  ^  to  -^-^  grain  of  mor- 
phia, or  J^  grain  of  opium,  or  the  extract  of  opium, 
is  usually  in  each.  Wistar's  Cough  Lozenges  contain 
powdered  opium  y^<j  grain,  oil  of  anise  -^j  grain,  ext. 
licorice  1  grain. 

Oil  of  Thymol : — 1  minim,  with  oil  of  anise  3  min- 
ims, to  half  a  pint  of  water  and  a  little  carbonate  of 
magnesia  is  useful  by  inhalation  in  cases  of  cough 
arising  from  dilated  bronchi. 

Terebene: — 20  drops  on  a  napkin  inhaled  daily  is 
especially  recommended  in  chronic  winter  coughs. 

Camphor  Chloral : — Painted  over  trachea  is  said  to 
allay  spasmodic  cough. 

Tr.  Iodine: — Painted  on  chest  affords  relief  of 
chronic  bronchial  catarrh. 

Oil  of  Sandalwood : — 6  minims  to  1  ounce  of  water 
as  an  inhalant  is  soothing  and  may  be  used  in  phleg- 
monous inflammation.     (Al.) 

Mucilaginous  drinks,  such  as  Flaxseed  Tea,  with 
Marshmallow,  decoction  of  Iceland  Moss,  "Whiskey, 
with  Glycerine  or  Rock  Candy.  Inhalations  of 
Steam,  Hot  Fomentations  around  throat. 


182  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Troches: — The  following  of  the  Pharmacopceia : 
Tannic  Acid,  for  relaxed  throat.  Ammonium  Chlor- 
ide, to  palliate  subacute  and  chronic  inflammation  of 
the  throat.  Catechu,  to  relieve  the  huskiness  and 
hoarseness  due  to  overuse  of  the  voice,  and  for  slight 
pharyngeal  and  laryngeal  cough.  Krameria,  same 
purpose  as  tannic  acid  or  catechu.     (N.) 


CROUP,  SIMPLE  CATARRHAL. 

Steam  Inhalations: — Water  should  be  kept  con- 
stantly boiling  in  the  room,  or  a  tent  may  be  placed 
over  the  patient  and  the  steam  allowed  to  enter. 
(Gn.) 

Hot  Compresses : — Flannels  waning  out  in  hot 
water  and  applied  to  throat  and  covered  with  oiled 
silk  are  useful.  Hot  Foot  Baths  to  the  knees  have  a 
good  effect.     (Ga.) 

Cold  Compresses : — Applied  to  lar\'nx  often  effect- 
ive in  the  commencement  of  an  attack  and  will 
relieve  mauA^  cases.  (Gn.)  Iced  Clcths  recom- 
mended in  cases  attended  with  much  fever.     (Ty.) 

Mustard  Plasters :  — As  counter-irritants  recom- 
mended to  be  always  applied.     (Ty.) 

The  temperature  of  room  should  be  between  68° 
and  75°.  Products  of  illuminating  gas  are  objec- 
tionable, gas  stoves,  therefore,  should  not  be  used 
for  croup  kettles.     (A.  W.) 

If  rhinitis  is  present  it  should  receive  prompt  treat- 
ment; the  following  sprays  are  suggested  for  this 
condition. 

^.    Mentholi,  gr.  v. 

Alboleni,  5j. 


CROUP,    MEMBRANOUS.  183 


Or, 

^. 

Cocainae  Hydrochloratis, 

gr.  j-ij. 

Acid.  Tannici, 

gr.  V. 

Aq.  Destill., 

3iv. 

M. 

Or, 

^. 

Hydrogen.  Peroxidi, 

3j- 

Gh'cerini, 

3Hj- 

M.  (Pep.) 


CROUP,  MEMBRANOUS. 

Antitoxin: — As  the  vast  majority  of  cases  on  ex- 
amination show  the  Klebs-Loeffler  bacillus,  all  are 
suitable  subjects  for  antitoxin.  "All  cases  of  laryn- 
geal diphtheria,  the  patient  being  two  years  or 
more,  should  receive  as  follows:  2000  units  at  the 
earliest  possible  moment ;  2000  units  after  12  or  18 
hours,  unless  there  is  improvement,  and  the  same 
dose  24  hours  after  the  second  dose  if  there  be  still 
no  improvement.  Patients  under  2  years  should  re- 
ceive 1000  to  1500  units."  Qac.)  "Nowhere  is  the 
serum  treatment  so  effective  as  in  these  cases ;  1000 
to  2000  units  should  be  given  at  once."  (T.  W.)  See 
also  Diphtheria. 

Calomel  Inhalation  : — Recommended  next  after  an- 
titoxin. (T.  W.)  Inhalations  under  a  tent  of  the 
sublimated  drug.  Use  8  to  10  grains  every  hour  or 
at  longer  intervals. 

Lime : — Slaked  under  a  tent  decidedly  beneficial 
and  very  generally  recommended,  the  patient  inhal- 
ing the  steam  from  the  slaking  lime.     (Jac.) 


184  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

The  following  are  for  constant  inhalation  from 
boiling  water : 

Carbolic  Acid,  gr.j-iv.     (F.) 

Oil  of  Turpentine,  1  to  5  drops,  with  glycerine,  5J, 
water,  §j.    (F.) 

Lime  Water  alone  or  with  equal  parts  of  water. 
(L.  T.)     Not  so  effective,  however,  as  slaked  lime. 

Tr.  Benzoin  Comp.,  one-half  drachm  to  a  pint  of 
water.     (L.  T.) 

Tr.  Iodine  or  Bromine,  a  few  drops  of  either  in  the 
croup  kettle  is  recommended  as  sometimes  of  service. 
(Gn.) 

Cold  : — Cold  w^ater  or  an  ice  bag  applied  to  the 
neck  is  sometimes  preferable  to  heat,  as  the  inhala- 
tion of  steam  is  not  alv^^ays  as  beneficial  as  it  ap- 
pears. (Jac.)  There  does  not  seem  to  be  any  special 
indication  for  the  use  of  cold  or  heat,  each  case  being 
a  rule  for  itself;  heat  may,  however,  be  said  to  be 
most  generally  effective  as  well  as  the  most  grateful. 

Papoyotin : — 1  part  to  10  of  glycerine  and  water 
may  be  applied  with  a  brush  or  spray ;  some  writers 
believe  this  drug  capable  of  dissolving  membranes. 
Solvents  of  this  nature  were  formerly  much  used. 

Lactic  Acid  : — In  more  or  less  saturated  solutions 
has  been  recommended  as  a  solvent  of  the  false  mem- 
branes, applied  with  spray  or  brush.  For  the  spray 
a  4  to  5  per  cent,  solution;  for  the  brush  a  some- 
w^hat  stronger  solution.     (F.) 

The  following  other  remedies  are  used  as  sprays : 

Hydrogen  Peroxide,  1  part  to  8  to  10  of  water. 

Sulphurous  Acid,  50  percent,  solution. 

Carbolic  Acid,  1  per  cent,  solution. 

Lime  Water,  pure. 


CYSTITIS.  185 

Tannic  Acid,  5  per  cent. 

For  other  remedies  of  this  nature  see  Diphtheria. 

Intubation  and  Tracheotomy. 

The  indications  for  these  measures  are  a  small 
rapid  intermittent  pulse,  aphonia,  cyanosis,  and 
marked  retraction  of  the  supra-scapular  fossae  and 
epigastrium  with  each  inspiration.  Either  should 
always  be  performed  when  the  child  is  suffocating. 

Intubation  : — In  most  instances  this  has  displaced 
tracheotomy  and  is  strongh^  endorsed.  It  never 
renders  the  latter  impossible. 

Tracheotomy: — May  be  preferred  to  intubation  for 
the  purpose  of  freeing  the  trachea  of  the  membrane. 


CYSTITIS. 

ACUTE  CYSTITIS. 

Hot  Fomentations  to  the  hypogastrium  and  peri- 
neum, and  Hot  Sitz  Baths  should  be  administered ; 
they  are  powerful  revulsives  for  abating  pelvic  con- 
gestion and  pain,  amelioration  being  sustained  for 
some  hours  after. 

Opium: — For  the  relief  of  pain,  suppositories  of 
opium  1  grain,  or  opium  and  ext.  belladonna,  each 
lA  grain.     (CI.)     Or, 


96.) 


p.    Morph.  Sulphatis, 

gr.  i 

Cocain.  Hydrochloratis, 

gr.i. 

Ext.  Belladonnae, 

gr.  tV- 

01.  Theobromae, 
M. 

gr.  xlv. 
(T, 

Sig.     Use  every  four  hours  until 

pain 

is  relieved. 

186  DIGEST   OF   EXTERNAL  THERAPEUTICS. 


^.    Ext.  Opii, 

gr.  J- 

Ext.  Hj'oscyatni, 

gr.  'X. 

Ol.  Theobromae, 

gr.  XV. 

M. 

(B.  H.) 

Sig.     Use  ever}'  hour  until  relieved. 

Morphia:  —  Hypodermically,  when  the  supposi- 
tories of  opium  constipate. 

Rehef  of  pelvic  congestion  ma^'  be  obtained  by  rest 
in  bed,  elevation  of  pelvis  with  flexion  of  the  thighs 
on  the  body  and  the  knees  supported  on  a  pillow^, 
evacuation  of  bov^els,  normal  cold  saline  enema  and 
counter-irritants  over  the  pubes  and  perineum.  The 
latter  may  be  applied  in  the  form  of  small  Blisters 
and  Hot  Fomentations,  changed  every  hour.  Tur- 
pentine Stupes  and  Mustard  Plasters  may  also  be 
employed.     (B.  H.) 

During  the  stage  of  decline,  if  there  is  a  tendency  in 
the  disease  to  become  chronic,  irrigations  of  the 
bladder  with  mild  antiseptic  solutions,  selected  with 
a  view  of  avoiding  any  irritation,  are  indicated,  such 
as  the  following : 

Potass.  Permang.,  1-2000. 

Creolin,  1-500. 

Boric  Acid,  1-100.     (B.  H.) 

CHRONIC  CYSTITIS. 

Local  treatment  consists  of  Irrigation,  Instillation, 
and  Drainage.     (B.  H.) 

Irrigation : — This  measure  is  of  the  greatest  service 
in  all  chronic  forms.  Marcy's  double  catheter  w^ith 
a  fountain  syringe  or  Skene's  apparatus  may  be 
used.  In  performing  irrigation  it  is  of  the  greatest 
importance  to  exclude  the  air  from  the  bladder ;  this 


CHRONIC    CYSTITIS.  187 

can  be  accomplished  by  causing  the  patient  to  retain 
a  small  quantity  of  urine,  so  that  when  the  catheter 
is  passed,  preparatory  to  the  washing,  the  urine  will 
pass  through  and  fill  it ;  if  the  bladder  is  empty  the 
catheter  should  be  first  filled.     (CI.) 

The  normal  bladder,  without  discomfort  holds 
from  six  to  eight  ounces,  but  it  is  rarely  admissible 
to  inject  more  than  three  or  four  ounces.  Injec- 
tions should  be  made  slowly,  and  the  irrigating 
fluid  must  be  at  a  temperature  of  90°  to  100°  F.  A  few- 
drops  of  a  4  per  cent,  solution  of  cocaine  may  be  in- 
stilled into  the  urethra  when  there  is  much  irri- 
tability.    (D.  H.) 

The  following  mild  solutions  are  recommended  for 
their  cleansing  effect  rather  than  for  stimulation : 

Potass.  Permang.,  1-5000  to  1-2000. 

Carbolic  Acid,  1-500. 

Boric  Acid,  1-50. 

Nitrate  of  Silver,  1-500. 

Saline  Solution,  7  per  cent.     (B.  H.) 

Other  solutions  for  irrigation,  some  of  which  are 
stronger  and  stimulating,  are  as  follows  (CI.): 

Potass.  Permang.,  1-250. 

Hydrogen  Peroxide  (15  vols.),  ^4  to  full  strength. 

Pyrozone,  3  per  cent,  to  fiill  strength. 

Aqueous  Hydrastis  (Emesty's),  .^j-Oj. 

Bichloride  of  Mercury,  1-2000  to  1-5000. 

Borax,  gj-Oj. 

Boric  Acid,  ,^— Oj. 

Sodium  Chloride,  3J— Oj. 

Of  the  above,  the  borax  solution,  according  to 
Carleton,  is  the  best.  The  following  are  also  recom- 
mended : 

Nitrate  of  Silver: — In  increasing  strengths  begin- 


188  DIGEST    OF   EXTERNAL  THERAPEUTICS. 

ning  with  y^  grain  to  the  ounce  and  running  up  to 
14  to  14,  or  even  10  to  15  grains  to  the  ounce  in  severe 
cases  where  strong  solutions  are  needed.     (D.  H.) 

Nitric  Acid: — A  drop  to  the  ounce  in  cases  where 
the  urine  is  ammoniacal  with  tendency  to  phos- 
phatic  deposit  and  formation  of  calcuH.     (D.  H.) 

Guaiacol: — 20  per  cent,  solutions  in  olive  oil;  1  to 
2  grains  of  the  injection  twice  daily ;  1  per  cent,  of 
iodoform  added  is  said  to  increase  its  efficacy.  This 
has  been  found  of  benefit  in  relieving  pain  and  fre- 
quent micturition.     (T.,  97.) 

The  following  is  recommended  by  Lutand,  of 
Paris: 

When  pain  and  inflammation  have  subsided,  an 
elastic  catheter,  to  which  a  syringe  is  attached,  is 
introduced  into  the  bladder  and  the  following  in- 
jected : 

9;.    Acid.  Borici,  Sj~ij- 

Sod.  Biborat.,  5J  S^-  ^v. 

Aq.  Destill.,  Oj  ^xij. 

M. 

Of  this  injection  one  to  one  and  a  half  ounces,  ac- 
cording to  the  irritability  of  the  bladder,  are  to  be 
injected.  This  is  followed  by  four  and  three-quarter 
ounces  of  warm  water  holding  the  following  mixture 
in  solution : 

Jt.    lodofonni,  3vij  gr.  xlij. 

Glycerini,  ^j-ij. 

Aq.  Destill.,  ,5  v. 

Gummi  Tragacanthae,  gr.  iv. 
M.  (T.,  96.) 

The  follow^ing  formula  for  an  irrigating  fluid  is  rec- 
ommended by  Dr.  Gouley : 


CHRONIC    CYSTITIS.  189 

^.    Hydrarg.  Bichlorid.,  gr.  v. 

Amnion.  Chlorid.,  gr.  xx. 

Spts.  Gaulther.,  ^ss. 

Acid.  Boric,  .  ^j. 

Glycerini,  Jviij. 

M. 

Sig.  To  one-half  ounce  of  the  solution  add  7  ounces  of  warm 
water  (110°)  and  2>^  ounces  of  hydrogen  peroxide.  This 
lo-ounce  mixture  should  be  sufficient  for  four  washings. 

Nosophen: — 4  per  cent,  solution  said  to  clear  the 
urine  in  a  few  days.     (Sj.) 

Acetate  of  Lead : — ^  grain  to  the  ounce  in  warm 
solutions  regarded  by  Sir  Henry  Thompson  as  one  of 
the  best  mild  injections  w^hen  the  urine  is  alkaline. 

Acetic  Acid: — The  following  combination  is  recom- 
mended by  Sir  Henry  Thompson  for  injection  after 
the  use  of  nitrate  of  silver : 

9;.    Plumb.  Acetat.,  ^ij. 

Acid.  Acetici  Dil.,  ^vj. 

Acid.  Carbolic,  gss. 

Aq.  Destill.,  ^iv. 
M. 

Sig.  I  drachm  of  the  solution  is  added  to  4  ounces  of  water 
and  injected  once  or  twice  a  day.     ( A. ) 

Creolin : — 1/2  per  cent,  solution  has  given  good  re- 
sults in  an  obstinate  case.     (Al.) 

Hydrochloric  Acid  : — When  the  urine  is  very  alka- 
line with  large  amount  of  phosphates  as  is  often 
seen  in  fracture  of  vertebrae  an  injection  of  a  solution 
containing  14  to  1  minim  to  the  ounce  may  be  used. 
(Al.) 

Curettage  : — Guyon's  method  for  painful  cystitis  in 
the  female  (19  cures  and  10  failures  reported)  is  as 
follows :  The  patient  is  anaesthetized  and  the  bladder 
irrigated  with  boric  acid  or  sublimate  solution  1— 


190  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

10,000,  and  a  medium  sized  Volkmiann  curette  is  in- 
troduced. While  the  left  index  finger  is  pressed 
against  the  vesico-vaginal  septum  as  a  guide,  the  in- 
strument is  moved  over  the  mucous  membrane  care- 
fully in  the  region  of  the  trigone  and  neck,  the  usual 
seat  of  the  disease ;  the  anterior  and  posterior  walls 
and  lastly  the  urethra  are  all  curetted.  A  self-retain- 
ing catheter  is  inserted  and  continued  for  fifteen  to 
twenty  days.  No  accident  is  recorded  in  the  above 
number  of  cases.     (T.,  98.) 

Dilatation  of  the  Urethra  in  the  Female: — A  large 
percentage  of  vesical  S3^mptoms  can  be  relieved  by 
this  procedure. 

Instillations: — These  are  made  with  an  instrument 
called  an  instillator,  which  is  a  silver  or  hard  rubber 
catheter  about  18  (French)  wnth  a  fine  canal,  to  the 
extremity  to  which  a  hypodermic  syringe  of  40 
minims  capacity  is  fitted.  In  applying,  the  syringe 
is  filled  with  the  selected  application,  the  catheter  in- 
troduced until  it  is  within  the  grasp  of  the  com- 
pressor urethrae  muscle,  and  the  fluid  injected  along 
the  membranous  and  prostatic  urethra,  and  into  the 
bladder.  Larger  syringes  may  be  employed,  holding 
1  to  2  drachms.  The  solutions  used  in  instillation 
are  the  following : 

Nitrate  of  Silver,  1  to  5  per  cent.,  especially  useful 
in  gonorrhoeal  cystitis. 

Bichloride  of  Mercury,  1-6000  to  2000. 

Iodoform  Emulsion,  10  per  cent.     (B,  H.) 

Vesical  Drainage: — Indicated  when  in  spite  of  all 
treatment  the  disease  progresses  and  the  danger  of 
nephritis  is  increasing.  The  simplest  and  safest  form 
of  drainage  is  by  the  urethra ;  this  is  attained  by  in- 
serting a  soft  rubber  catheter  of  medium  size,  and 


CYSTS.  191 

retaining  it.  The  catheter  should  be  watched  to  see 
that  the  flow  of  urine  is  continuous,  and  changed 
every  forty -eight  hours.  Mild  antiseptic  solutions 
should  be  used  twice  daih^  for  irrigating.  (B.H.) 
The  other  methods  for  continuous  drainage  are  by 
perineal  and  suprapubic  incision.  For  the  relative 
merits  of  these  procedures,  see  works  on  genito- 
urinary surgery. 


CYSTS. 

Paraffine  : — Sometimes  used  to  distend  the  walls  of 
a  collapsed  C3'st  in  order  to  facilitate  its  removal.  It 
is  injected  in  a  liquid  state  and  allowed  to  cool,  thus 
affording  better  facility  for  the  dissection  of  the  cyst 
walls.     (Al.) 


DANDRUFF. 

See  Pityriasis. 

DERMATITIS   HERPETIFORMIS. 

Washes  are  usually  more  grateful  than  ointments 
for  soothing  the  itching  and  irritation.  The  follow- 
ing formulae  will  be  found  convenient  and  useful : 

9;.    Acid.  Carbolici,  3iij- 

Glycerini,  ^j. 

Aq.  Destill.,  Oj. 

M. 


192  DIGEST   OF    EXTERNAL   THERAPEUTICS. 

Or, 

9;.    Amnion.  Ichthyoli,  3ss-j. 

Ol.  Amygdalae  Dulcis, 

Aq.  Calcis,  aa  ^j. 

M. 

Sig.     To  be  rubbed  in  several  times  daily  and  allowed  to  re- 
main on  the  surface.     (Vn.) 

Sulphur: — ^sij— ^,  according  to  Duhring,  the  most 
valuable  of  all  local  applications  except  in  the  ery- 
thematous form,  when  it  proves  irritating.  It  should 
he  well  rubbed  in  and  not  smeared  on. 

Thiol:  — 10  per  cent,  solutions  used  twice  daily 
have  been  successful.  (Sm.)  This  drug  is  similar  to 
ichthyol  in  action  w^ith  the  advantage  of  being  less 
disagreeable  in  odor. 

Starch  Baths  with  Bicarbonate  of  Soda  can  be 
used  frequently. 

Other  remedies  recommended  are  Lassar's  Paste, 
Resorcin  Ointment,  Liq.  Carbonis  Detergens,  ^ij 
Tvith  Avater  .^viij.  Calamine  Lotion,  Liq.  Picis  Alka- 
linus,  and  Tar  Ointment. 

It  is  better  to  begin  with  the  mildest  application 
and  use  stronger  as  the  disease  advances. 


DERMATITIS   VENENATA. 

Lotio  Nigra: — According  to  Van  Harlingen,  cloths 
saturated  w^ith  this  lotion  kept  constantly  applied 
give  very  satisfactory  results.  White  says  the  remedy 
should  not  be  used  over  extensive  surfaces  for  fear  of 
absorption,  or  if  used,  should  only  be  applied  for  half 
an  hour,  two  or  three  times  a  day. 


DERMATITIS   VENENATA.  193 

The  following  is  recommended  by  White  for  use  on 
extensive  surfaces  in  place  of  the  black  w^ash : 

9^.    zinc.  Oxidi,  giv. 

Acid.  Carbolici,  33. 

Aq.  Calcis,  Oj. 

M. 

Sig.     Shake  well  and  sop  on  as  often  as  desired,  or  when  itch- 
ing causes  sleeplessness.     (Wh.) 

Cypripedium: — 1  part  in  4  to  5  parts  of  water  is 
used  with  success  in  California.     (Boe.) 

Grindelia: — A  remedy  \vhich  has  given  excellent  re- 
sults in  the  proportion  of  2  to  4  drachms  of  the  fluid 
extract  to  a  pint  of  water.  Apply  on  cloths  thor- 
oughly soaked  with  the  solution  and  allow  them  to 
become  almost  dry  on  the  skin,  then  renew;  not 
keeping  them,  in  other  words,  constantly  w^et,   (Vn.) 

Zinc  Sulphate: — Solution  of  3SS-5J,  forms  one  of 
the  best  applications.  (F.)  Apply  on  cloths  every 
hour  during  the  day. 

\A^ashing  Soda: — Sometimes  nothing  is  so  effective 
as  this  domestic  remedy  in  solution.     (Vn.) 

Aq.  Calais: — Applied  with  cotton  and  lint  kept 
constantly  saturated  will  afford  prompt  relief  in 
many  cases.     (Ja.) 

Salol: — 3  per  cent,  solutions  especially  recom- 
mended.    (M.  R.,  5,  11,  98.) 

Acetate  of  Lead : — An  effective  remedy,  but  should 
be  used  with  caution,  if  at  all,  when  the  skin  is 
broken,  as  its  application  is  then  dangerous.  It  may 
be  employed  as  follows : 

^.    Liq.  Plumbi  Subacetat.  Dilut.,  ^j. 

Aq.  Destill.,  ^iij. 

M.  (B.  H.) 


14 


194  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Or, 

ffc.    Liq.  Plunibi  Subacetat.  Dilut.,  3J-"j- 

Tr.  Opii,  3ij-iv. 

Aq.  Destill.,  Oj. 

M.  (Al.) 

Burow's  solution  modified  as  follows  is  said  to 
afford  particularly  good  results : 

9;.    Plumbi  Subacetatis,  3j- 

Aluminis,  Jiij- 

Aquae,  Oj. 

M.  (M.  R.,  5,  II,  98.) 

Sodium  Hypophosphite  : — Recommended  by  Mor- 
row. It  maj'  be  applied  in  a  simple  solution  of  6 
drachms  to  the  ounce  (Sh.)  or  the  following: 

5fc.    Sodii  Hypophosphitis,  5j. 

Glycerini,  gss. 

Aq.  Destill.,  ad  gviij. 

This  may  be  applied  by  lint  soaked  in  the  solution 
and  held  in  place  by  bandages.     (Ja.) 

Tar: — The  following  will  be  found  of  service  for 
children  with  whom  it  is  difficult  to  use  compresses 
or  bandages.  It  is  indicated  when  the  itching  is 
severe  and  the  skin  is  broken : 

^.    Picis  vel  01.  Cadini,  3j. 

Collodii,  ,^j. 

M. 

Gelatin  : — Recommended  by  White,  viz.: 

9;.    Gelatini,  3^^. 

Glycerini,  5j. 

Aquae,  ^iv. 
M. 

When  applications  in  the  form  of  ointment  are  de- 
sired, the  following : 


^. 

Acid.  Tannici, 

gr.  XV. 

Petrolati, 

SJ- 

M. 

Acid.  Carbolici, 

gr.  x-xx. 

Hydrarg.  Chlorid.  Mitis, 

gr.  X. 

Pulv.  Amyli, 

SJ- 

Petrolati, 

IJ. 

M. 

(Vn.) 

The  latter  when  there  is  much  itching. 

Europhen  : — 10  per  cent,  in  vasehne,  after  washing 
the  parts  in  a  saturated  solution  of  bicarbonate  of 
soda.     (Sj.) 

Cold  Cream,  Zinc  Oxide  Ointment,  or  Diachylon 
Ointment  (half  strength),  also  useful.     (Ja.) 

Astringent  powders  will  prove  useful  when  it  is  not 
convenient  to  apply  wet  dressings,  especially  when 
the  face  is  uncovered,  viz.: 

9;.    Pulv.  Zinc.  Carbon.  Prsecipitati, 

Amyli  Oryzse,  aa   ^j. 

M. 

Or, 

9;.    Magnesii  Carbon.  Levis, 

Pulv.  Lycopodii,  aa  Jj. 

M.  (Vn.) 


DIPHTHERIA. 

Antitoxin  Serum  : — It  should  be  borne  in  mind 
that  the  antitoxin  serum  in  the  market  is  of  varying 
strength,  that  of  each  sample  being  indicated  either 
by  the  amount  required  to  neutralize  a  given  quan- 
tity of  normal  toxin   (German  method),  or  by  its 


196         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

poNv^er  of  counter-acting  a  unit  of  toxic  strength.  It 
must  also  be  borne  in  mind  that  unfortunately  the 
samples  of  serum  in  the  market  are  not  always 
either  what  they  claim  to  be,  nor  are  all  the  samples 
of  the  same  make  always  uniform. 

Dose: — 1500  to  2000  units  for  the  first  injection 
for  a  child  of  2  years,  in  laryngeal  stenosis  and  all 
severe  cases,  to  be  repeated  in  from  eighteen  to 
tw^enty-four  hours;  if  there  is  no  improvement,  a 
third  dose  after  a  similar  period  if  necessary.  1000 
units  for  first  dose  for  severe  cases  in  children  under 
two  years  and  for  mild  cases  over  that  age,  repeated 
if  necessary  in  from  eighteen  to  twenty-four  hours. 
A  second  dose  is  not  usually  required.  The  dose 
should  always  be  estimated  in  units  and  not  in  the 
amount  of  serum. 

Quality: — The  most  concentrated  strength  of  an 
absolutely  reliable  preparation  should  be  used. 

Time  of  Administration: — It  should  be  adminis- 
tered as  early  as  possible,  not  waiting  for  confirma- 
tion of  clinical  diagnosis  by  bacteriological  culture. 
If  the  case  is  seen  late,  injections  should  be  made,  un- 
less it  is  progressing  favorably.     (T.,  97.) 

Rules  of  the  Pasteur  Institute: — For  the  use  of 
Roux's  serum : 

Preventive  Action:  A  dose  of  1%  drachms  lasts 
from  four  to  six  weeks. 

Therapeutic  Action : — 1^4  to  2i/^  drachms  for  benign 
cases  at  the  onset ;  4  to  6  drachms  in  serious  cases, 
or  w^hen  they  have  passed  several  days,  up  to  1 
ounce  or  even  more  in  severe  cases ;  4  to  6  drachms 
w^hen  breathing  is  embarrassed  may  render  tracheot- 
omy unnecessary.  If  improvement  is  not  satisfac- 
tory, inject  2V2  to  4  drachms  more.    It  is  better  to 


DIPHTHERIA.  197 

inject  at  the  onset  a  dose  stronger  than  necessary, 
cutting  short  the  malady,  than  to  inject  weak  ones 
at  intervals. 

For  infants  under  one  year,  inject  15  minims  for 
each  month;  for  adults,  except  in  extremely  severe 
cases,  it  is  not  necessary  to  inject  more  than  4  to  6 
drachms  for  the  first  time.     (Sj.) 

Dosage  According  to  Behring: — According  to  se- 
verity of  case  600  to  1000  or  1500  units;  this  dose 
may  be  repeated  if  the  symptoms  have  not  improved 
within  a  day.  Qac.)  Small  doses  at  intervals,  ac- 
cording to  Behring,  are  more  serviceable  than  larger. 
When  the  infection  is  virulent,  600  units  is  a  full 
dose.     (Sj.) 

Dosage  for  Immunization. 

I  to  3  months,  50  units. 

3  to  4        "  75 

4  to  6        "  100 
6  months  to  i  year,  150 

1  to  2  years,  175 

2  to  4      "  200 
Adults,                                                             400 

(T.,98.) 

Tectinique: — The  skin  at  the  locality  of  puncture, 
the  syringe,  and  the  hand  of  the  physician  should  be 
rendered  thoroughly  aseptic.  The  injection  should 
be  made  into  the  loose  subcutaneous  tissue,  and  not 
into  the  muscles ;  it  should  always  be  injected  into  a 
part  upon  which  there  is  no  pressure,  and  in  all  cases 
a  special  syringe  should  be  used  which  admits  of 
thorough  sterilization  each  time  before  use.  The 
point  of  injection  should  be  covered  with  antiseptic 
gauze  or  iodoform  collodion. 


198         DIGEST  OF   EXTERNAL  THERAPEUTICS. 

Local  Treatment. 

All  authorities  agree  that  local  treatment  is  of  the 
greatest  importance,  and  should  be  commenced  im- 
mediately, in  order  to  assist  in  checking  the  exuda- 
tion, correcting  the  foul  odors  and  preventing  the  re- 
absorption  of  the  poison.  The  remedies  which  have 
been  recommended  for  this  purpose  are,  as  is  well 
known,  exceedingly  numerous ;  therefore,  only  those 
w^hich  have  met  v^ith  more  general  approbation  are 
mentioned.  The  removal  of  the  exudate  is  desirable, 
but  all  undue  irritation  of  the  pharynx  by  instru- 
ments, forcible  removal  of  the  membrane,  or  irritat- 
ing applications,  have  been  shown  to  tend  to  the 
extension  of  the  diphtheritic  exudation  and  are  to  be 
condemned. 

Hydrarg.  Bichlorid.: — Solutions  of  this  remedy  are 
of  great  value.  When  used  in  the  form  of  a  spray, 
care  should  be  taken  that  it  is  not  too  coarse,  lest 
an  excess  be  throv^n  on  the  surface,  and  cause  in- 
jurious absorption,  when  applied  for  a  long  period. 
(F.)  It  may  be  employed  as  an  irrigating  solution 
in  the  strength  of  1-3000  or  1-4000  (Al.);  as  a 
spray  1-5000  (Bos.)  also  1-2000  to  1-10,000;  for 
application  with  a  swab  1-1000,  in  young  children 
with  caution.  (Pep.)  A  solution  of  1-20  in  glycerine 
has  been  recommended,  preceded  by  a  boric  acid  spray, 
and  applied  two  or  three  times  a  day  with  cotton 
tampons  soaked  in  the  solution.  Carefully  remove 
all  excess  to  prevent  toxic  effects. 

Salicylic  Acid,  in  solutions  of  1—1500,  or  a  satur- 
ated solution  of  Boric  Acid  may  be  used  instead  of 
the  bichloride  with  very  young  infants.     (Pep.) 

Hydrogen  Peroxide : — Of  great  service  to  cleanse 


DIPHTHERIA.  199 

and  deodorize,  used  in  various  dilutions  from  one- 
half  to  one-third.  It  is  especially  recommended  undi- 
luted as  a  spray  in  the  laryngeal  form  of  diphtheria. 
This  remedy  is  objected  to  on  account  of  its  property 
of  coagulating  the  soluble  albumen  of  the  tissues, 
causing  pseudo-membranes,  which  fall  off  and  leave 
surfaces  ready  for  fresh  invasion.  It  is  none  the  less 
valuable.  Being  non-poisonous  it  is  harmless  when 
swallowed,  an  important  factor  in  the  treatment  of 
young  children. 

Potass.  Permang.: — 1  grain  triturated  with  1 
ounce  of  sugar  of  milk  and  gum  acacia,  blowm  on 
affected  part  every  two  or  three  hours.  Application 
must  be  very  thorough  in  order  to  be  effective ;  the 
powder  should  be  thrown  into  every  accessible  part. 
Before  application,  the  peroxide  of  hydrogen  spray 
must  be  used,  thoroughly  cleansing  the  parts.  All 
the  froth  must  be  carefully  removed  before  the  per- 
manganate is  applied.  This  treatment  is  especially 
recommended  by  Goodno.  It  may  also  be  used  as  a 
gargle  for  cleansing  the  mouth,  gr.  iij-5J. 

Lactic  Acid  : — One  of  the  best  solvents.  Mackenzie 
used  3  drachms  of  the  acid  to  10  ounces  of  water,  to 
be  employed  as  a  spray.  It  may  also  be  used  as  a 
gargle,  putting  sufficient  acid  in  the  water  to  make 
it  taste  sour.  When  employed  as  a  spray  take  care 
to  protect  the  eyes.  (B.)  Applied  topically  it  is 
highly  recommended  in  5  per  cent,  solution,  or 
stronger,  according  to  the  effect.     (Bos.) 

Slaked  Lime  : — A  saucer  contained  slaking  lime 
placed  in  the  room  and  the  fumes  allowed  to  impreg- 
nate the  air  is  especially  recommended.  It  is  an  old 
and  effective  remedy.     It  is  claimed  to  be  decidedly 


200         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

better  than  lime  water  sprays  to  the  throat,  which 
are  almost  without  effect.     (Jac.) 

Thymol : — After  septic  coagula  are  removed,  this  is 
useful  in  the  proportion  of  2  to  20  grains  alone,  or 
with  5  grains  of  carbolic  acid,  to  the  ounce  of  water 
and  glycerine.  It  may  be  employed  as  a  spray  or 
gargle.     (Al.) 

Toluol : — Loeffler  has  used  the  following  combina- 
tion, in  which  menthol  seems  to  deaden  the  pain  of 
the  application : 

Menthol,  lo  grams. 

Toluol,  enough  to  make  36  c.  c. 

Absolute  Alcohol,  60  c.  c. 

Liq.  Ferric  Chloride,  4  c.  c. 

Remove  the  superficial  mucus  and  apply  a  swab  saturated  with 
the  mixture,  pressing  it  firmly  for  ten  seconds  over  a  given  spot; 
repeat  this  until  the  whole  membrane  has  been  thus  treated. 

This  treatment,  it  is  claimed,  gives  good  results. 
(T.  W.)  In  a  series  of  seventy-one  cases  all  are  said 
to  have  been  saved;  in  another  series  treated  after 
the  second  day,  out  of  twenty-six  one  only  was  lost. 

Liq.  Ferri  Perchloridi: — 1  part  to  4  of  alcohol  ap- 
plied under  illumination  with  a  probe  wrapped  in 
cotton;  the  whole  surface  of  the  membrane  is 
touched  gently  wdth  the  remedy.  Care  should  be 
observed  that  the  solution  is  confined  to  the  exuda- 
tion and  no  injury  is  done  to  the  parts.  This  method 
has  some  strong  endorsements.  (Bos.)  Subsul- 
phate  of  Iron  or  the  Tr.  Chloride  of  Iron  are  also 
used. 

Carbolic  Acid: — In  proportion  of  15  grains  to  1 
ounce  of  glycerine  and  water,  as  a  spray ;  stronger 
solutions  may  be  used  w^ith  a  swab.     (Ty.) 


DIPHTHERIA.  201 

The  following  is  recommended  by  Pepper  when  the 
bichloride  cannot  be  used  : 

5fc.    Acid.  Carbolici,  gtt.  xij. 

Liq.  Calcis,  ^iv. 

M. 
Sig.     Apply  with  atomizer  every  half  hour. 

Iodoform: — Saturated  solution  in  ether,  or  5  per 
cent,  suspended  in  equal  parts  of  glycerine  and  w^ater 
are  useful  preparations. 

Potassium  Chlorate: — A  saturated  solution  as  a 
simple  wash  for  the  mouth.     (Ty.) 

Menthol: — 1  per  cent,  solution  in  alcohol,  applied 
by  painting  by  means  of  cotton  wool,  three  times  a 
day,  has  given  remarkable  effects.     (T.,  96.) 

Pyoktanin  Blue: — Saturated  solutions  have  been 
employed  -with  encouraging  results.  Applications 
should  be  made  with  a  cotton  covered  probe,  and 
spray  to  every  part  of  the  upper  respiratory  track. 
It  should  be  employed  early  if  possible.     (Gn.) 

Solutions  of  this  drug  being  unstable  they  should 
be  kept  in  dark  glass  bottles,  and  renewed  everj^ 
eight  days.  It  is  incompatible  with  corrosive  subli- 
mate.    A  3  per  cent,  solution  has  also  been  used. 

Warm  Saline  Solutions: — Useful  for  cleansing  pas- 
sages, but  do  not  cause  the  bacilli  to  disappear  as 
quickly  as  the  bichloride  does.  Plain  warm  w^ater 
will  irritate  while  alkaline  solutions  will  not.    (Sj.) 

Papayotin: — Valuable,  according  to  Jacobi,  for  dis- 
solving the  membrane.  May  be  injected,  sprayed  or 
swabbed  on.  It  is  soluble  in  20  parts  of  water,  and 
is  used  in  that  strength  and  stronger,  as  1  part  to  1 
or  4  of  water  and  glycerine.  It  may  be  applied  to 
nose  and  throat  or  through  the  tracheotomy  tube. 

Trypsin : — Recommended  as  a  solvent  in  place  of 


202  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

the  above.    It  acts  only  \vhen  neutral  or  alkaline. 
The  following  has  been  emplo^^ed : 


9;.    Sod.  Benzoatis, 

SHJ- 

Sod.  Bicarbonatis, 

3J-"J- 

Trypsin., 

ZJ- 

01.  Eucalypti, 

EJ- 

Liq.  Calcis, 

Oj. 

M. 

9.    Trypsin., 

gr.  XXX. 

Sod.  Bicarbonatis, 

gr.  X. 

Aquae, 

^i- 

M. 

Sig.    Make  a  smooth  mixture  and 

apply 

with 

a  brush  or  spray. 

Another  formula  with  bichloride  of 

mercury  is  as 

follows : 

9.    Trypsin., 

Sod.  Bicarbonatis, 

aa  3ss. 

Aquae, 

.^j. 

Hydrarg.  Bichlorid.,               v 

gr.X. 

Glycerini, 

3J. 

M. 

Warm  this  mixture  and  apply  with  a  brush.  When 
the  membrane  begins  to  soften,  spray  every  hour 
w^ith  peroxide  of  hydrogen,  1  part  to  6  of  water. 
(Al.)  These  solvent  remedies  were  formerly  much  in 
vogue,  but  have  fallen  into  disuse. 

Myrrh  : — The  undiluted  tincture  has  been  employed 
w^ith  success  for  painting  the  throat  and  tonsils; 
while  for  the  larvmx  mixed  wnth  glycerine  it  proves  a 
useful  inhalation. 

Nasal  Injections  and  Irrigations: — These  can  be 
used  to  wash  the  pharjmx  and  tonsils  as  well  as  the 
nasal  cavitj'-,  and  to  do  aw^aj'^  with  special  treatment 
of  the  throat.  This  is  very  desirable,  as  frequently 
children  will  not  permit  the  throat  to  be  treated  or 


DIPHTHERIA.  203 

even  open  the  mouth,  without  force  being  used  and 
consequent  injurious  excitement  and  disturbance. 
The  following  are  recommended  : 

Bichloride  of  Mercury,  1-3000  or  4000  (Sj.)  or  1 
part  with  35  of  salt  and  5000  of  water.  Caution  in 
regard  to  swallowing  in  young  children.  Boric  Acid 
acts  as  well  as  the  bichloride,  §ss-Oj  (Sj.);  it  may  be 
used  in  a  saturated  solution.  Lime  Water,  pure. 
Carbolic  Acid,  1  per  cent,  with  caution  in  giving 
children  lest  it  be  swallowed.  Solutions  of  Sodium 
Hyposulphite.     (Jac.) 

Medicated  Steam  Inhalations  : — Are  often  of  great 
service,  and  may  be  used  in  many  instances  with 
benefit.  They  may  be  employed  as  mentioned  under 
pseudo-membranous  croup. 

Steam  Inhalations  : — These  are  very  useful  for  soft- 
ening the  membrane.  They  are  more  useful  in 
tracheo-bronchial  diphtheria  than  in  that  of  the  ton- 
sils.    (Jac.) 

Dusting  Powders  : — These  are  of  doubtful  utility, 
and  generally  contra-indicated  on  account  of  the  local 
irritation,  cough  and  general  disturbance  caused  by 
their  administration.  Calomel  and  perhaps  lodol 
are  exceptions.     Qac. ) 

Among  the  numerous  other  remedies  are  the  fol- 
lowing : 

Tr.  Iodine,  1-40.  Liq.  Sodse  Chlorinatae,  1-20. 
Sulphurous  Acid,  1-10.  Condy's  Fluid,  1-40.  So- 
dium Hyposulphite,  .^ss- 5j.     (Al.) 

Guaiacol  and  Menthol : — The  following  has  proved 
especially  effective  as  a  prophylaxis  to  be  painted  on 
the  throat  and  tonsils : 


204  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Guaiacol,  lo  parts. 

Menthol,  i  part. 

Sterilized  Olive  Oil,  lo  parts. 

(Saj.) 

LARYNGEAL    DIPHTHERIA.     See    Membranous 
Croup. 

NASAL  DIPHTHERIA. 

This  form  of  the  disease  is  apt  to  terminate  fatally 
unless  very  energetic  treatment  is  adopted  at  once. 
The  nose  should  be  persistently  and  faithfully  irri- 
gated or  syringed  with  an  antiseptic  solution  every 
hour  night  and  day  for  one  or  two  days.  The  child 
should  be  awakened  to  have  the  solution  applied.  It 
is  a  fatal  kindness  to  permit  it  to  sleep.  Employ  the 
solutions  previously  mentioned,  giving  preference  to 
those  which  are  non-poisonous,  when  there  is  danger 
of  swallowing. 

Sometimes  the  nostrils  are  completely  occluded  by 
the  membrane.  In  this  case  a  passage  must  be  tun- 
nelled with  the  probe  and  forceps ;  the  probe  may  be 
tipped  with  cotton  and  dipped  in  carbolic  acid.  Co- 
caine may  be  used.   (Gn.) 

A  glass  syringe  w^ith  a  soft  rubber  mounting  in 
front  is  the  best  for  administering  the  injection. 
When  the  patient  cannot  be  raised,  a  nose  cup  or  a 
spoon  may  be  preferred. 

The  manner  of  sj^ringing  is  very  important.  It 
should  be  applied  horizontally,  and  the  fluid  should 
not  come  out  of  the  same  nostril. 

Absolute  quiet  is  very  essential;  all  unnecessary 
furniture  and  all  drapery  should  be  removed.  When 
possible  it  is  well  to  change  the  patient's  room  to 
prevent  reabsorption  of  the  poison.     (Jac.) 


DYSENTERY.  205 


DYSENTERY. 

ACUTE  DYSENTERY. 

Rest  in  bed  and  use  of  the  bed  pan  is  important,  as 
frequent  risings  are  injurious.  (Gn.)  Starch  Injec- 
tions with  20  to  30  drops  of  laudanum  after  each 
stool  are  helpful.  Mucilaginous  Enemata  will  often 
allay  tenesmus.  Opium  Suppositories  for  pain  and 
tenesmus.  Hot  Compresses  or  a  large  Flaxseed 
Poultice,  containing  about  half  an  ounce  of  mustard, 
often  acts  satisfactorih'.     (Bt.) 

Bismuth  and  Acacia: — Haifa  drachm  of  each  with 
an  ounce  of  water,  injected  once  or  twice  daily,  ac- 
cording to  the  severity  of  the  symptoms  and  retained, 
is  of  value  in  tropical  forms.     (Al.) 

Lysol: — 1  per  cent,  aqueous  solution  as  an  enema. 
(T.,  96.) 

Irrigation  of  the  Rectum  and  Colon: — This  is  the 
most  rational  treatment  of  the  severer  forms.  The 
large  intestine  of  the  adult,  it  should  be  remem- 
bered, holds  about  six  imperial  pints,  but  not  more 
than  three  or  four  should  be  introduced.     (Pp.) 

The  method  of  administering  recto-colon  irrigation 
is  important ;  the  patient  should  lie  on  the  left  side 
w^ithout  a  pillow,  with  the  hips  well  elevated ;  the 
fluid  should  be  introduced  slowl3^  resting  when  there 
is  an  inclination  to  reject.  When  pain  is  experienced 
the  injections  should  be  discontinued.  The  plan  is 
entirelv  safe  except  when  deep  ulcers  have  formed. 
(Gn.)  " 

The  following  are  recommended  for  irrigation : 

Sterilized  \Vater. 


206  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Boric  Acid,  gr.  x-|j. 

Quinine,  1-1000  or  1-5000,  used  by  Osier  in  the 
amoebic  form. 

Salicylic  Acid,  1  to  2  per  cent.,  or  1-300  for  child- 
ren. 

Bichloride  of  Mercury,  1-6000. 

Alum,  3j-0j. 

Tannic  Acid,  1  to  2  per  cent. 

Nitrate  of  Silver,  gr.  ss— |j. 

The  irrigations  are  administered  at  a  temperature 
of  100°  to  110°  F.,  though  some  of  the  older  writers 
advocated  their  use  cold.  The  Germans  use  iced 
water  injections.  If,  on  account  of  the  irritability 
of  the  bowels,  large  injections  cannot  be  tolerated, 
as  is  frequently  the  case,  small  ones  may  be  substi- 
tuted, and  the  quantity  increased  gradually.  Pre- 
vious to  administration  it  is  often  advisable  to  allay 
the  sensitiveness  of  the  part  by  small  injections  of  a 
4  per  cent,  solution  of  cocaine  or  small  enemata  of 
starch  and  laudanum.     (An.) 

This  method  of  treatment  is  little  called  for  in  the 
ordinary  types  of  the  disease,  it  is  more  especially  in- 
dicated in  the  severer  and  amoebic  or  tropical  varie- 
ties. 

Acetate  of  Lead : — Useful  in  both  acute  and  chronic 
forms  for  the  relief  of  tenesmus ;  the  following  may 
be  given  by  injection : 

9;.    Plumbi  Subacetatis,  gr.  iv. 

Morph.  Sulphatis,  gr.  ss. 

Aq.  Fervid.,  |j. 
M.  (B.) 


DYSMENORRHCEA.  207 

CHRONIC  DYSENTERY. 

Intestinal  Irrigation  : — The  method  of  administra- 
tion and  the  solutions  advocated  for  the  acute  form 
of  the  disease  are  also  indicated  in  the  chronic ;  the 
reader  is,  therefore,  referred  to  the  preceding  article. 

Before  use  the  bowel  should  be  well  flushed  with 
tepid  water  and  freed  from  all  faecal  and  other  irri- 
tating matter. 

Nitrate  of  Silver  : — Is  especially  endorsed  by  many 
writers  when  there  is  ulceration  of  the  bowels ;  after 
the  cleansing  enema,  inject  by  means  of  a  long  flexi- 
ble rubber  tube  carried  up  into  the  colon,  using  a  so- 
lution of  gr.  X— XX— Oj.  Care  should  be  observed  in 
inserting  the  tube  so  as  not  to  wound  the  inflamed 
surfaces.  (B.)  Another  usefiil  solution  consists  of 
nitrate  of  silver  gr.  xx,  tr.  opium,  gtt.  xx-xxx,  water 
Oij,  repeated  as  required.  (Sj.)  Stronger  solutions 
have  been  employed.  Amelioration  follows  the  third 
or  fourth  washing,  but  a  course  of  sixty  are  said  to 
be  necessar\^  for  a  cure.    (An.) 

Sulphate  of  Copper: — Gr.  v-x-§j,  an  effective  in- 
jection for  ulceration  and  inflammation  of  the  rec- 
tum.    (F.) 

Examine  the  rectum  for  ulceration. 


DYSMENORRHCEA. 

All  cases  are  relieved  by  rest  in  the  recumbent 
posture.  Hot  applications  to  the  abdomen  and  Hot 
Vaginal  Douches.  (K.  C.)  Scarification  of  the 
Cervix  followed  bj^  Glycerine  Tampons  and  Hot 
V^ater  Injections  give  good  results  if  persistently 


208  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

employed  between  periods.  They  are  indicated  in  the 
congestive  variet3^     (T.,  97.) 

Galvanism  : — Of  service  in  all  forms,  especially  the 
neuralgic.  Cleanse  the  vagina  \vith  hot  bichloride 
solution,  1—2000,  and  dip  the  intra-uterinc  electrode 
in  a  stronger  solution  of  the  same ;  the  intra-uterine 
electrode  is  introduced  to  the  fundus,  while  the  other 
is  placed  over  the  abdominal  wall.  The  positive  pole 
is  used  if  the  uterine  canal  is  patulous  and  the  flow^ 
too  free;  when  the  canal  is  contracted,  the  uterus 
small  and  flow  scanty',  the  negative.  The  seance 
should  last  about  fifteen  minutes,  and  the  strength 
of  the  current  should  be  from  20  to  40  milliamperes. 
(K.  C.) 

Spinal  Ice  Bag,  w^hen  discharge  is  scanty ;  if  pro- 
fuse. Hot  \A^ater  Bag;  during  intervals.  Hot  or  Cold 
Sitz  Baths.     (R.) 


DYSPHAGIA. 

Cocaine  : — A  very  valuable  agent  for  relieving  this 
symptom.  In  the  last  stages  of  laryngeal  tuberculo- 
sis, a  spray  a  few  moments  before  taking  food  will 
enable  the  patient  to  swallow^  w^ith  comparative 
ease.    (Al.) 

The  follow^ing  is  recommended  by  insufflation  in- 
stead of  cocaine : 

^.    Morph.  Hydrochloratis, 

Sac.  Lactis,  aa  gr.  xx. 

Gum.  Arabici,  gr.  xv. 

M. 
Sig.     Use  half  a  grain  before  meals. 

The  effect  is  said  to  last  many  hours.     (T.,  96.) 


DYSPNCEA.  209 

Menthol: — 10 to 20  per  cent,  solution  in  vaseline  as 
a  spray  is  especially  useful  in  the  dysphagia  of  laryn- 
geal phthisis.     (Al.) 

Orthoform :  —  In  laryngeal  phthisis,  cleanse  the 
ulcerations  and  insufflate  with  the  drug,  or  apply 
the  following  with  the  laryngeal  spray : 

5fc.    Mentholi,  lo. 

Ol.  Amyg.  dulc,  30. 

Vitelli  Ovi  (about  two  yolks),  30. 

Orthoformi,  12.5 

Aq.  Destill.,  q.  s.  ad  100. 

M. 

Marked  relief  follows  this  measure.  (T.  P.,  6,  99.) 
Lactic  Acid: — Varying  from  10  to  100  per  cent.; 
begin  with  a  weak  solution.  It  is  one  of  the  best 
topical  applications  for  laryngeal  phthisis  with 
ulcers  of  the  vocal  cords.  Dysphagia  is  almost 
always  lessened  and  sometimes  ceases  after  its  use. 
Application  is  usually  made  with  a  brush  every  other 
da3'  at  first,  then  daily ;  a  burning  sensation  may  be 
produced  which  will  continue  several  hours ;  this 
may  be  relieved  by  10  to  15  per  cent,  applications  of 
cocaine.     (Al.) 

Ice — Slowly  swallowing  iced  drinks  will  sometimes 
allay  spasmodic  forms.     (Wa.) 


DYSPNCEA. 

Oxygen  Inhalations: — Used  w^hen  pulmonary  and 
cardiac  disease  is  the  cause ;  often  a  useful  palliative. 

Amyl  Nitrite: — Inhalations  w^hen  of  cardiac  origin 
with  high  arterial  tension.     (F.) 

Ethyl  Iodide: — According  to  See  this  remedy'  gives 
15 


210  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

prompt  and  satisfactory  relief  in  the  dyspnoea  of 
phthisis.  (Al.)  The  frequency  of  administration  will 
depend  upon  the  severity  of  the  case,  and  the  dura- 
tion upon  the  immediate  effects.  The  average  time 
is  about  four  minutes  and  the  frequencj^  about  six 
times  a  day.  If  vertigo  is  produced  the  inhalation  is 
too  long. 

Dry  Cups: — Applied  to  chest  and  back  give  tempor- 
ary relief  in  acute  pulmonary,  pleural,  and  cardiac 
diseases. 

Inspiration  of  Condensed  Air: — Beneficial  in  dysp- 
noea arising  from  many  forms  of  disease ;  namely, 
lar3mgeal  and  trachial  stenosis  and  chronic  disease 
of  the  bronchi  and  lungs  in  all  stages,  especially  the 
earlier.     (F.) 


EARACHE. 

See  also  Otitis. 

Hot  fomentations  of  Chamomile  Flowers,  Hops 
or  Poppy  Heads.     (F.) 

Cocaine : — 5  to  10  per  cent,  solution  A^erv  effective. 
(B.) 

Atropine: — Gr.  iij-v-^j,  1  or  2  drops  in  the  ear  is  of 
value,  especially  when  of  rheumatic  origin.     ( Al. ) 

Chloroform  : — Insufflation  of  the  vapor  sometimes 
effective.     (F.) 

The  following  often  afford  relief,  a  few  drops  on 
cotton  inserted  into  the  ear : 

Tr.  of  Aconite  of  great  value.  Glycerine,  Ham- 
amelis,  Arnica,  Oil  of  Cloves,  Opium  in  the  form  of 


ECTHYMA.  211 

Laudanum,  or  Morphine  in  solution.    All  these  rem- 
edies should  be  heated  before  applying.     (Bt.) 

Syringing  with    hot  water  at  short    intervals  is 
effective  in  some  cases.     (Bt.) 


ECCHYMOSIS. 

See  Contusions. 

ECTHYMA. 

Local  treatment  consists  first  in  getting  rid  of  the 
parasites  when  present,  after  which  treatment  should 
be  on  general  antiseptic  principles.  Crusts,  if  numer- 
ous, are  to  be  removed  by  baths,  preferably  those 
containing  Potassium  Sulphuret,  or  by  Starch  Poul- 
tices containing  Boric  Acid  (see  Acute  Eczema).  The 
parts  are  then  to  be  cleansed  with  Sublimate  Soap 
or  Carbolized  Lotions  or  Bichloride  of  Mercury 
Solutions,  1-1000.  The  lesions  are  then  dressed 
with  an  ointment  of  Boric  Acid,  1  drachm,  or  Calo- 
mel, 15  grains,  to  Zinc  Oxide  Ointment,  1  ounce. 
(Vn.) 

A  compress  soaked  in  Boric  Acid  Solution  may  be 
applied  to  the  lesions  and  covered  w^ith  rubber  tissue. 
(B.H.) 

Salicylic  Acid: — 5  to  10  grains  to  the  ounce  of  oil 
or  ointment  base  acts  well.     (Ja.) 

Carbolic  Lotions: — When  ulcers  show  little  ten- 
dency to  heal,  a  weak  carbolized  wash  may  be  used. 
(Kp.) 


212  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Ung.  Hydrarg.  Ammon.: — 20  grains  with  zinc 
oxide  ointment,  1  ounce  (Ja.);  or  5  to  10  grains 
with  cosmoline,  1  ounce,  forms  an  excellent  anti- 
septic ointment.     (Kp.) 

Aristol,  Dermatol,  Iodoform,  lodol,  and  remedies 
of  that  class  in  the  form  of  ointments  are  all  service- 
able. 

Cod  Liver  Oil : — May  be  used  externally  with  good 
results.     (F.) 


ECZEMA. 

ACUTE  AND  SUBACUTE  ECZEMA. 

Applications  should  be  of  a  soothing,  sedative 
character,  in  the  more  acute  forms,  and  slightly 
stimulating  in  the  subacute;  dusting  powders,  lo- 
tions, and  ointments  are  employed.  When  a  remedy 
is  applied  for  the  first  time  in  acute  eczema  it  is 
better  to  use  it  over  a  limited  area,  and  thus  ascer- 
tain its  effects ;  for  what  has  suited  one  case  will  not 
answer  necessarily  for  another  w^ith  the  same  ap- 
parent characteristics.  Linen  or  muslin  used  for 
dressings  should  be  disinfected  before  each  applica- 
tion, and  care  observed  that  there  are  no  creases  or 
folds  when  laid  on  the  surface.  It  should  be  of  the 
thinnest,  softest  variety,  and  if  the  patient  is  sensi- 
tive to  cold  a  fold  of  flannel  may  cover  the  dressing. 

Starch  Poultice: — One  of  the  best  moist  applica- 
tions. Potato  starch  is  preferable;  it  should  be 
mixed  with  5  to  10  parts  of  boric  acid  per  1000, 
placed  in  a  flat  bag,  dipped  in  boiling  water  and 
allowed  to  cool  before  applying.    In  some  cases  the 


ECZEMA.  213 

starch  may  be  made  into  a  paste  and  covered  with 
very  fine  Hnen  carefully  adjusted.  No  form  of  treat- 
ment, according  to  Van  Harlingen,  gives  more  relief 
in  acute  eczema  if  carefully  applied  and  changed 
every  six  hours.  In  mild  cases,  or  in  the  later  stages, 
the  parts  may  be  covered  wath  a  few  turns  of  a  soft 
linen  bandage  which  has  been  impregnated  with  a 
decoction  of  bran  or  starch  water.     ( Vn. ) 

Dusting  Powders. 

These  are  of  service  for  the  redness,  vesication,  pus- 
tulation,  and  serous  exudation — they  may  be  bland, 
astringent  or  sedative. 

Corn  Starch,  Arrcw  Root  and  Rice  are  the  most 
soothing;  Magnesium,  Zinc  Oxide,  Bismuth,  and 
Lead  Carbonate  the  most  astringent  and  sedative. 

Corn  Starch: — Should  be  applied  at  first  on  all 
large  surfaces  and  the  parts  then  covered  with  linen. 

Zinc  Oleate: — 1  drachm,  with  powdered  arrow- 
root, 1  ounce,  indicated  when  a  mild  astringent  is 
desired.     (Sh.) 

Lycopodium,  Kaolin,  Subnitrate  of  Bismuth,  Der- 
matol and  Talc,  alone,  or  associated,  are  useful  for 
isolated  patches.     (Vn.) 

When  itching  is  very  severe  and  obstinate : 

9;.    Camphorae,  3^- 

Zinc.  Oxidi,  5ij- 

Amyli,  '^iv. 

M.  (Ja.) 

In  acute  vesicular  or  erythematous  forms  water, 
according  to  most  writers,  is  irritating;  it  should, 
therefore,  only  be  employed  for  the  requirments  of 
cleanliness.    Olive  Oil  has  been  recommended  as  a 


214  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

substitute   for    water.      Pustular    eczema    requires 
washing  with  soap  and  water  at  intervals. 

Lotions. 

Lotio  Nigra: — The  following  is  recommended  for 
the  acute  vesicular  variety,  and  constitutes  one  of 
the  best  forms  of  treatment  for  the  majority  of  cases 
in  the  early  acute  stages :  The  affected  part  is  bathed 
w^ith  the  lotion,  full  strength  or  diluted  with  equal 
parts  of  lime  water,  and  covered  with  cloths  satur- 
ated with  the  same.  The  following,  which  clings  to 
the  skin,  may  be  substituted  for  use  on  the  face : 

?fe.    Hydrarg.  Chlorid.  Mitis,  Jss. 

Mucil.  Tragacanthae,  ^j. 

Iviq.  Calcis,  ^xj. 

M. 
After  the  wash  has  been  applied  some  minutes  rub  on  oxide  of 
zinc  ointment,  or  this: 

9^.    Pulv.  Zinc.  Oxidi,  gr.  Ixxx. 

Ung.  Aq.  Rosi*;, 

Vaselini,  aa   .^iv. 

M. 
Apply  gently  with  the  fingers.     The  treatment  is  repeated  at  in- 
tervals of  a  few  hours.     (Hy. ) 

Lotio  Flava: — May  be  used  with  the  same  indica- 
tions as  lotio  nigra.     (Sh.) 

Liq.  Plumbi  Subacetatis  Dilutus: — Useful  in  vari- 
ous forms ;  a  pint  with  half  an  ounce  of  glycerine,  or 
w^ith  laudanum,  2  ounces  of  each  to  a  pint  of  v^ater. 
When  there  is  a  good  deal  of  inflammation,  and  the 
skin  is  oedematous,  a  bread  poultice  mixed  with  ice 
cold  lead  water  has  a  soothing  and  grateful  effect. 
(Vn.) 

Compound  Zinc  Oxide  Lotion : — This  remedj^  also 


ECZEMA.  215 

called  Startin's  Lotion,  has  the  widest  range  of  appli- 
cation ;  it  is  as  follows : 


Zinc.  Oxidi, 

^ss. 

Pulv.  Calaminse  Prseparatae, 

9iv. 

Glycerini, 

Ij- 

Liq.  Calcis, 

Ivij. 

M. 

Grindelia  Robusta  : — Suitable  for  the  treatment  of 
large  surfaces,  half  an  ounce  of  the  fluid  extract  to  a 
pint  of  w^ater.  Apply  with  cloths  and  allow  to  re- 
main on  until  quite  dry.     (Vn.) 

Carbolic  Acid: — One  of  the  most  effective  antipruri- 
tics, though  rarely  adapted  to  the  acute  stage ;  but 
when  itching  is  intense  and  burning  is  not  a  promi- 
nent symptom  it  may  be  used  w^ith  good  effect  either 
as  a  simple  lotion  in  the  strength  of  a  drachm  to  a 
pint  of  water  (Sh.),  or  in  combination  with  black 
wash,  as  foUow^s  : 

Jfc.    Acid.  Carbolici,  3ij~iv. 

Glycerini,  5]- 

Lotio.  Nigrse,  Oj. 

M. 

These  applications  are  more  adapted  to  the  erythe- 
matous varieties,  w^hen  the  skin  is  unbroken  and 
there  is  inflammatory  infiltration.  (Vn.)  In  these 
conditions  w^eaker  solutions  of  carbolic  acid  will  also 
give  good  results. 

Glycerine: — Alone  will  prove  irritating,  but  diluted 
with  three  parts  of  water  will  form  an  agreeable  ap- 
plication.    (Vn.) 

Zinc  Sulphate: — Gr.  xv— xxx— ^j,  sometimes  very 
useful  for  application  on  the  hands.     (Vn.) 

Cloths  wrung  out  in  Hot  ^Vater  and  applied  very 
hot  in  quick  succession  w^ill  often  allay  the  itching 
when  other  remedies  have  failed. 


216  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Alum: — In  the  form  of  Burow's  Liquor,  is  useful. 
When  there  is  intense  oedema  and  loss  of  serum,  to 
the  extent  of  causing  weakness,  use  5  to  10  parts 
with  100  of  water  on  compresses,  renewing  every 
three  hours.     (Kap.) 

Boric  Acid,  Sodium  Carbonate,  Sodium  Hyposul- 
phite and  Sodium  Sulphite,  all  in  the  proportion  of 
1  drachm  to  a  pint  of  water,  are  also  used  as  lotions. 

Nitrate  of  Silver: — Sometimes  a  solution  of  3  to  10 
grains  to  the  ounce  painted  on  moist  patches  w^ill 
act  satisfactorily.     (Ja.) 

Ointments. 

As  a  rule,  ointments  do  not  agree  wdth  acute 
eczema  as  well  as  lotions,  yet  there  are  cases  in 
which  they  are  preferable.  Cold  Cream,  Cucumber 
Cream,  alone  or  wath  arrow  root,  and  Glycerite  of 
Starch  are  the  most  bland. 

Zinc  Oxide: — 1  drachm,  with  cold,  cream  1  ounce, 
is  very  soothing,  and  better  than  the  ordinary  zinc 
ointment,  which  is  apt  to  be  too  hard.     (Sh.) 

Ung.  Zinc.  Benzoat.: — This  is  one  of  the  best  reme- 
dies after  the  acute  stage  (Ja. ) ,  though  disapproved 
by  some  writers. 

Lassar's  Paste  (See  Appendix  II): — Indicated  when 
there  is  much  discharge,  as  in  pustular  and  weeping 
eczema.  10  to  15  grains  of  salicylic  acid  may  be 
added  to  increase  its  antipruritic  effect.     (Ja.) 

Diachylon  Ointment : — This  should  be  prepared 
with  great  care,  as  improperly  made  it  is  harmful. 
The  method  of  preparation,  according  to  Duhring,  is 
as  follows :  Olive  oil  15  ounces,  powdered  litharge  3 
to  4  drachms,  water  a  sufficient  quantity.    The  oil  is 


ECZEMA.  217 

to  be  mixed  with  1  pint  of  water  and  heated  by  a 
steam  bath  to  boiling,  the  finely  powdered  litharge 
is  sifted  in  and  stirred  continually ;  the  boiling  is  to 
be  continued  until  the  minute  particles  of  the  lith- 
arge have  entirely  disappeared.  During  cooling,  a 
few  more  ounces  of  water  are  to  be  added  from  time 
to  time,  and  when  completed  v^ater  will  remain  in 
the  vessel.  The  mixture  is  to  be  stirred  until  cool. 
When  properly  prepared,  the  ointment  should  be 
yellowish  gray  and  of  the  consistency  of  butter.  It 
is  best  applied  on  cloths  and  covered  with  oiled  silk 
for  cleanliness. 

Menthol: — 5  to  20  grains  in  an  ounce  of  zinc  oint- 
ment is  useful  to  allay  itching.     (Al.) 

Iodoform : — Gr.  v-x-§j  with  lard  is  one  of  the  best 
remedies  in  the  pustular  form.     (Ck.) 

Alumnol: — 10  to  20  per  cent,  ointments  are  recom- 
mended by  Bulkley. 

The  following  forms  an  excellent  soothing  applica- 
tion: 

9^.    zinc.  Oxidi,  31]. 

Acid.  Salicylici,  gr.  x. 

Amyli,  ^ij. 

Vaselini,  3  iv. 
M.  (Kp.) 

Zinc  Oleate  : — Combined  with  equal  parts  of  olive 
oil,  or  with  equal  parts  of  ung.  aq.  rosas  with  a  little 
almond  oil,  is  often  valuable.     (Vn.) 

Bismuth  Oleate : — The  following,  known  as  Mc- 
Call  Anderson's  Ointment,  is  an  elegant  combina- 
tion : 


218         DIGEST  OF   EXTERNAL  THERAPEUTICS. 

^.    Bismuth.  Oxidi,  3J. 

Acid.  Oleici,  ^j. 

Cerae  Albse,  ^iij. 

Vaselini,  p^  ix. 

Ol.  Rosae,  M.ij. 
M.  (And.) 

Bismuth  Subnitrate:  —  As  a  mild  astringent  and 
sedative,  is  especially  valuable  in  acute  eczema  of  the 
scalp  in  children,  as  follows  : 

5fe.    Bismuth.  Subnitratis,  5ss-j. 

Ung.  Aq.  Rosse,  ^j. 

M.  (Vn.) 

To  relieve  the  itching  the  following : 

9?.    Bismuth.  Subnitratis,  3J. 

Glycerini,  3  ij . 

Acid.  Carbolic.  Liquid.,  M.xij. 

Aq.  Rosse,  q.  s.  ad   ^j. 

M. 
Sig.    Shake  well  and  apply  with  a  camel's  hair  brush.  (Sn.) 

Salicylic  Acid : — In  strengths  varying  from  2  to  20 
per  cent.,  -with  lanolin,  vaseline  or  water,  is  satisfac- 
tory in  subacute  erythematous  varieties  when  con- 
fined to  small  areas.  This  remedy  is  also  effective  in 
weak  solutions  in  vesiculo-pustular  forms,  but  its 
best  results  are  seen  in  eczema  rubrum  and  eczema 
squamosum  when  there  is  considerable  fissuring.  (F.) 

Xeroform: — A  10  per  cent,  solution  w^ill  check  the 

discharge  in  eczema  madidum  and  impetiginosum. 

(F.) 
Picric  Acid: — Saturated  solutions  painted  on  the 

part  have  been  highly  praised  in  acute  and  subacute 

eczema.     (T.,  98) 

Potass.  Permang.: — 1   to  2  per  cent,  or  stronger 

solutions    have   been    recommended    by    Bulkley  in 

patches  of  subacute  forms. 


ECZEMA.  219 

In  eczema  intertrigo  the  following  will  prove  use- 
ful: 


^. 

Bismuth.  Subnitratis, 
Zinc.  Oxidi, 

3iv. 
33- 

Pulv.  Amyli, 
Acid.  Carbolici, 

3ij- 
M.v- 

•XV. 

M. 

Vaselini  vel  Ung.  Aq.  Rosae, 

q- 

s.  ad 

5J. 

(B.  H.) 

Thymoli, 

Pulv.  Zinc.  Oleati, 

M. 

(Ja.) 

9;. 

Acid.  Salicylici, 
Pulv.  Amyli, 
Bismuth.  Subnitratis, 

aa 

gr.  X. 

M. 

Ung.  Aq.  Rosa;, 

q- 

s.  ad 

SJ- 

(B.H.) 

CHRONIC  ECZEMA. 

In  some  cases  the  treatment  employed  for  the  acute 
form  w^ill  also  be  applicable  to  this  type  of  the  dis- 
ease, but  as  a  rule  more  stimulating  remedies  will  be 
found  necessary. 

Tar  : — This  remedy  is  largely  employed.  It  is  indi- 
cated in  the  squamous  form,  and  when  the  disease 
has  become  decidedly  chronic  with  more  or  less  infil- 
tration. If  applied  when  not  indicated  it  will  irritate 
and  retard  recovery.  Mild  preparations  should  be 
used  first  and  increased  in  strength  as  indicated. 
The  two  forms  of  tar  commonly  employed  are  Pix 
Liquida  and  Oleum  Cadini.  The  following  formulae 
are  suggested : 


220  DIGEST   OF  EXTERNAL  THERAPEUTICS. 


^. 

Ol.  Cadini, 

3SS-J 

Zinc.  Oxidi, 

3SS-J 

Ung.  Aq.  Rosae, 

3j. 

M. 

Or, 

P. 

Ol.  Cadini, 

33- 

Ung.  Zinc.  Oxid, 

Benzoat. , 

SJ. 

M. 

Pix  liquida  may  be  substituted  in  the  above  for  the 
oleum  cadini  in  double  the  strength.     (Ja.) 

Compound  Tincture  of  Mineral  Tar  (Coal  tar,  1 
part  digested  wath  6  parts  of  tincture  of  quill  aia, 
with  frequent  agitation  for  not  less  than  eight  days, 
preferabl3^  longer,  then  filtered): — This  is  an  excellent 
preparation  in  which  to  employ  tar  in  a  liquid  form, 
especially  in  dry  eczema  of  the  scalp  in  adults.  It 
should  be  used  in  the  strength  of  3  to  20  minims  to 
the  ounce  of  water.     (T.,  98.) 

Tar  Baths: — Are  advised  by  Lassar  for  the  purpose 
of  disinfecting  the  skin ;  after  the  bath  the  surface  is 
dusted  with  Venetian  talc.     (T.,  97.) 

Oleum  Rusci: — Effective  but  is  difficult  to  obtain. 
It  may  be  used  in  the  proportion  of  1  to  2  drachms 
to  the  ounce  of  ung.  aq.  rosas.  (B.  H.)  Another  ex- 
cellent way  in  which  to  use  tar  is  that  of  the  strong 
tincture,  2  parts  to  1  of  alcohol.  Paint  the  diseased 
surface  w^ith  about  three  coats,  allow^ing  each  coat 
to  dry  before  the  other  is  applied ;  then  cover  with 
oxide  of  zinc  ointment,  vsrhich  should  be  changed 
every  morning.     Qa. ) 

The  following  is  recommended  in  old  patches  to  be 
rubbed  in  with  a  mop : 


ECZEMA.  221 

^.    Picis  Iviquidae, 

Sapo.  Viridis, 

Alcoholis,  partes  equales. 

M.  (Vn.) 

In  very  chronic  thickened  varieties  tar  has  been 
recommended  to  be  used  pure,  dissolved  in  olive  oil  if 
the  lesions  are  extensive.  Caution  must  be  observed 
lest  poisonous  effects  be  produced. 

^A(^ilkinson's  Ointment: — Advised  by  Lassar  in  ob- 
stinate forms.  It  consists  of  equal  parts  of  sulphur 
and  oleum  rusci,  1  part;  prepared  chalk,  ^  part; 
soft  soap  and  vaseline,  2  parts.     (T.,  97.) 

Carbolic  Acid: — A  very  valuable  agent,  especiallj' 
serviceable  as  an  antipruritic.  It  will  often  allay 
itching  when  other  remedies  have  failed,  and  may  be 
used  in  the  form  of  an  ointment ;  5  to  20  grains  to 
the  ounce  of  base,  either  benzoated  lard  or  zinc  oxide 
ointment.     (Vn.) 

Thymol : — An  ointment  of  10  grains  to  the  ounce 
and  upward  is  used.     (F.) 

Thioform  : — 10  per  cent,  salves  are  strongly  recom- 
mended in  moist  forms.     (T.,  96.) 

Sulphur: — A  very  useful  remedy,  especiall^^  when 
the  surface  is  moist.  It  is  indicated  in  pustular 
eczema  of  the  hands,  in  chronic  eczema  rubrum  oc- 
curring in  patches,  and  when  it  is  desired  to  renew 
the  epithelium  of  the  skin  by  its  comifying  powers. 
It  maybe  employed  in  the  strength  of  1  to  2  drachms 
to  the  ounce  of  vaseline  or  cold  cream,  but  should  be 
used  mild  at  first  and  gradually  increased  in 
strength.  It  is  regarded  by  some  writers  as  next  to 
tar  in  efficacy,  forming  one  of  the  best  stimulating 
remedies.  It  is  not,  however,  as  reliable,  and  in 
some    persons    causes    considerable    dermatitis.    A 


222  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

combination  of  sulphur  and  tar  has  good  effect  in 
old  chronic  cases  attended  with  much  itching  and 
infiltration.     (Vn.) 

Sapo  Viridis : — Often  of  the  greatest  service,  espe- 
cially in  eczema  rubrum  of  the  leg  and  other  parts 
where  there  is  extensive  infiltration.  It  should  be 
rubbed  in  thoroughly'  by  means  of  a  piece  of  flannel, 
until  there  is  considerable  smarting  and  copious 
serous  discharge.  The  soap  is  then  washed  off  with 
warm  water,  the  parts  well  dried,  and  a  soothing 
ointment,  such  as  diachylon,  applied.  The  procedure 
is  repeated  daih',  and  is  effective  in  this  form  of  the 
disease.     (Vn.) 

Lassar's  Paste  (See  Appendix  II.  for  formula): — 
May  be  useful  in  some  cases  but  is  better  for  the 
acute. 

Vasogene  or  Oxygenated  Vaseline: — Made  by  boil- 
ing vaseline  with  4  per  cent,  of  nitric  acid,  washing 
away  the  excess  of  acid  and  cooling,  has  given  very 
satisfactory  results  in  dry  and  weeping  eczema.  (T., 
98.) 

Salicylic  Acid,  Salol,  or  Resorcin: — In  strength 
varying  from  20  to  60  grains  to  the  ounce  of  oint- 
ment base,  useful  when  there  is  more  infiltration 
than  inflammation.     (T.,  98.) 

Bassorin  Paste : 

ffc.    Bassorini,  gx. 

Dextrini,  3vj. 

Glycerini,  ^ij. 

Aquae,  q.  s.  ad  gxxvss. 

M.  (Ck.) 

Ichthyol: — Varying  strengths  are  used  to  reduce 
the  thickening  in  old  cases.     (F.) 
Thiol : — As  a  substitute  for  ichthyol,  to  which  it  is 


ECZEMA.  223 

very  similar  but  free  from  odor,  2  to  15  per  cent, 
ointments,  and  50  per  cent,  solutions.     (T.,  96.) 

Resorcin: — 2  to  5  per  cent,  ointments  are  useful  as 
mild  stimulants  in  lotions  or  ointments.  For  ery- 
thematous eczema  the  following : 

9;.    Resorcini,  gr.  x-xv. 

Glycerini,  M.x. 

Liq.  Calcis,  ^j. 
M. 
Sig.     Apply  to  the  part  three  or  four  times  daily  until  itching 

and  burning  cease,  and  the  inflammation  lessens.     (T. , 
9S.) 

Caustic  Potash: — 10  to  40  grains  to  the  ounce  may 
be  advantageously  employed  in  old  infiltrated  cases 
and  in  eczema  of  the  palms.  The  application  should 
be  mopped  on,  the  parts  then  bathed  wath  cold 
water  or  covered  wnth  cold  water  compress,  and 
after  a  w^hile  w^ith  soothing  ointments.  This  proced- 
ure is  heroic  as  well  as  effective,  and  must  be  used 
w^ith  care.  It  should  never  be  used  more  than  once 
or  twice  a  week,  and  never  intrusted  to  the  patient 
for  application.     (Vn.) 

A  preparation  introduced  by  Bulkley  called  Liq. 
Picis  Alkalinus  is  the  follow^ing: 

9:.    Picis  Iviquidae,  ^ij. 

Potass.  Causticse,  3J. 

Aq.  Destill.,  3  v. 

M. 

Sig.     This  is  to  be  diluted  with  from  2  to  8  parts  of  water. 

(B.  H.) 

Mercurial  Ointments: — Valuable  when  the  disease 
is  limited,  but  should  not  be  used  over  extensive 
areas  for  fear  of  absorption. 

Some  of  the  preparations  in  use  are  as  follows : 


224    DIGEST  OF  EXTERNAL  THERAPEUTICS. 


5fe. 

Hydrarg.  Chlorid.  Mitis, 
Ung.  Zinc.  Oxidi, 

gr.  x-xxx. 

Ung.  Petrolei, 

aa  ^ss. 

M. 

Or, 

^. 

Hydrarg.  Oxid.  Rub., 

gr.  v-xxx. 

Vaselini, 

^j- 

M. 

(Vn.) 

Rubber  Protective: — For  the  reduction  of  infiltra- 
tion and  the  removal  of  scales,  nothing  is  better  when 
used  for  a  limited  period.  A  piece  of  rubber  is  applied 
to  the  part,  and  bound  down  with  a  roller  bandage. 
It  should  be  removed  once  a  da3%  sponged  with  a 
solution  of  soda  in  water  and  reapplied.  This  plan 
affords  great  relief  to  the  itching.  As  soon  as  infil- 
tration is  reduced  the  tar  remedies  are  indicated. 
(Ja.)  Martin's  Solid  Rubber  Bandage  is  of  great 
service  in  varicose  eczema  rubrum.  The  bandage 
should  be  worn  during  the  day  onlj^,  and  on  remov- 
ing at  night  the  limb  should  be  bathed  in  hot  water, 
dried  and  dusted  with  starch  powder,  and  loosely- 
covered  veith  linen  for  the  night.     (Hy.) 

Ihle's  Paste : — A  well  known  and  useful  applica- 
tion is  the  foUov^ing : 

9r.    Resorcini,  gr.  x-xx. 

Zinc.  Oxidi, 

Pulv.  Amyli, 

Lanolini, 

Vaselini,  aa  3ij- 

M. 

Plasters  : — The  mull  and  salve  plasters  of  Unna  be- 
ing now  obtained  in  this  country  can  be  used  with 
good  effect.  They  are,  however,  expensive  and  liable 
to  become  rancid.  Pick's  salicylated  plaster,  a  sub- 
stitute is  as  follow^s : 


ECZEMA. 

M. 

Emplastri  Saponis, 
Ol.  Olivse, 
Acid.  Salicylici, 

5  iiss. 

3v. 

gr.  xxxvij 

Duhring  recommends  for  a  5 

per 

cent. 

plaster : 

M. 

For  a 

Emplastri  Saponis, 
Ol.  Olivse, 
Acid.  Salicylici, 

,  lo  per  cent,  plaster, 

omit  the  olive  oil. 

aa 

'.  gr.  xxiv. 

225 


Hardaway  uses  lead  plaster  61  parts,  powdered 
soap  4  parts,  and  water  sufficient  to  form  a  paste 
with  the  soap.  Add  the  lead  and  evaporate  to  proper 
consistency.  Then  add  vaseline  30  parts,  salicylic 
acid  5  parts,  and  mix  with  gentle  heat.  The  salicylic 
acid  may  be  increased  if  necessary. 

These  plasters  are  especially  indicated  in  infiltrated 
varieties  of  eczema.  After  the  thickening  has  been 
removed,  the  salicylic  acid  may  prove  injurious,  in 
which  case  it  should  be  replaced  by  simple  ointments 
or  pastes. 

Gelatin  Preparations  : — These  were  recommended 
by  Pick  as  a  vehicle  for  other  remedies  and  as  a  pro- 
tective. The  following  are  among  the  best  of  the 
numerous  formulae  (Pick's  Gelatin): 

9;.    Gelatinae,  3  iv. 

Zinc.  Oxidi,  3  iiss. 

Glycerini,  ^  ss. 

Aquae,  ^vj. 
M. 

Heat  the  water,  dissolve  the  gelatine  in  it,  then  add  the  gly- 
cerine and  zinc;  stir  until  cold. 

For  use  the  liquid  jelly  is  heated  in  a  hot  water 
bath  and  painted  on.    One-half  per  cent,  of  ichthyol 
16 


226  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

or  ati)^  other  remecU'  used  in  diseases  of  the  skin,  ex- 
cept lard,  may  be  added  if  desired.     (B.  H.) 

Gelanthum  : — Introduced  by  Unna  and  modified  by 
Skinner,  is  as  follows : 

$6.    Tragacanthae,  5"^^- 

Gelatin.  Opt.,  3ij. 

Glycerini,  5vj. 

Thymoli,  gr.  %. 

Aq.  Destill.,  q.  s. 

M. 
Place  the  tragacanth  and  glycerine  in  a  covered  jar  containing  lo 
ounces  of  water  and  add  enough  to  make  12  ounces.  (B.  H.) 

Jamieson's  Gelatin : 

Gelatin,  15  parts. 

Zinc  Oxide,  10  parts. 

Lard,  10  parts. 

Glycerine,  65  parts. 

Heat  together  in  a  hot  water  bath,  and  add  2  per  cent,  salicylic 
acid.     Apply  with  a  brush.     (Vn.) 

Pigments : — Various  remedies  are  added  to  collo- 
dion or  liquid  gutta  percha,  thus  constituting  a  pig- 
ment. In  small  thickened  patches  of  eczema  Salicylic 
Acid  and  Chrysarobin,  of  each  5  to  10  per  cent.,  are 
valuable,  and  in  eczemas  about  the  mouths  of  chil- 
dren Tar  similarly  combined  is  often  useful,  viz.: 

9;.    01.  Cadini,  5J. 

Collodii  vel  Traumaticini,  ^j. 

M.  (B.  H.) 

ECZEMA  IN  CHILDREN. 

Treatment  is  generally  on  the  same  lines  as  that 
for  adults.  When  the  face  is  the  seat  of  the  disease, 
it  should  be  covered  with  a  light  linen  mask  held  in 
place  by  being  fastened  to  a  skull  cap.    The  oint- 


ECZEMA.  227 

ments  should  be  spread  on  cloths  and  the  mask  put 
on  over  them.  Suitable  openings  must  be  made  for 
the  nose,  mouth,  and  eyes. 

All  parts  of  the  skin  which  are  in  apposition  should 
be  kept  separated  by  folds  of  lint.  Scales  should  be 
removed  as  directed  for  eczema  of  the  scalp,  after 
which  the  selected  remedj^  may  be  applied. 

Kaolin,  Zinc  Oxide,  Bismuth  Subnitrate  are  suit- 
able dusting  pOAvders  for  the  erythematous  variety ; 
Starch  may  also  be  used,  but  boric  acid  must  be 
added  to  prevent  caking  and  consequent  irritation. 

Black  Wash  and  Dilute  Lead  ^Vater  are  often  of 
service. 

Resorcin: — For  the  disease  w'hen  situated  on  the 
scalp  and  for  dr\''  scaly  patches  elsewhere  the  follow- 
ing is  useful : 

1^.    Resorcini,  gr.  viij-xv. 

Sulphur.  Lotionis,  S^s— j. 

I<anolini,  5ss-3ijss. 

Adipis,  q.  s.  ad  ^iij  5ij- 

M.  (N.  Y.  M.  J.,  4,  I,  99.) 

Boric    Acid: — The    powder    or    an    ointment,    1 
drachm  to  vaseline  1  ounce.     (Vn.) 
For  obstinate  cases  of  the  scaly  type : 

Tar, 

Alcohol, 

Green  Soap,  equal  parts. 


Or, 


Oil  of  Cade,  i  part. 

Olive  Oil,  I  part. 

Lanolin,  "lo  parts. 


228  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Or, 

Zinc  Oxide.  i  part. 

Ammonia  Hydrate,  i  part. 

Oil  of  Almonds,  i  part. 

Tar,  ID  parts, 

(Jac.) 

The  following  are  for  use  in  the  vesicular  and  vesi- 
culo-pustular  forms : 

fk.    Pulv.  Zinc.  Carbonatis,  3J. 

Ung.  Cucumis,  3j. 

M. 

Or, 

1^.    Bismuth.  Subnitratis,  3j. 

Ung.  Aq.  Rosae,  ^j. 

M.  (Vn.) 

Balsam  of  Peru: — 1  to  30  in  vaseline;  apply  at 
night  (T.,  96),  or  w^ith  boric  acid  as  follows. 


(Sn.) 


M. 

Acid.  Borici, 
Balsam.  Peru., 
Vaselini, 

gr.  Ixx. 
gr.  V. 

Tar 

: — In  mild  chronic  conditions : 

M. 

Picis  Liquidae, 
Pulv.  Zinc.  Oxidi, 
Ung.  Aq.  Rosae, 

3SS. 

3ss. 

Or: 

M. 

Sulphur.  Praecipitati, 
Picis  Liquidae, 
Ung.  Zinc.  Oxidi, 

• 

3SS-J. 

Eh 

Or, 

^. 

01.  Cadini, 
CoUodii, 

3J. 

Eh 

ECZEMA.  229 

Methylene  Blue : — 3  per  cent,  solutions  in  w^ater 
have  proved  effective  for  eczemas  of  the  ano-genital 
region.  It  is  analgesic,  soothing,  antiseptic  and 
protective.     (N.  Y.  M.  J.,  4,  1,  99.) 

Salicylic  Acid: — For  seborrhoeal  forms  the  follow- 
ing: 

9;.    Acid.  Salicylici,  gr.  iij-viij. 

Pulv.  Zinc.  Oxidi,  3  ij  gr.  xv. 

Pulv.  Amyli,  giv. 

Tr.  Benzoin.  Comp.,  gij  gr.  xv. 

Adipis,  ^iij  ^ij. 

M.  (N.  Y.  M.  J.,  4,  I,  99.) 

Nitrate  of  Silver: — 10  to  40  grains  to  1  ounce  gives 
good  results  in  chronic  cases  of  the  squamous  and 
crustaceous  variety.     Qac.) 

The  nails  should  be  kept  cut  short  in  order  to  pre- 
vent scratching. 

ECZEMA  OF  REGIONS. 

Eczema  of  the  Anus. 

The  treatment  is  generally  the  same  as  that  of  the 
infiltrated  variety  in  other  localities.  The  parts 
should  be  washed  with  Ichthyol  or  mild  Sublimate 
Soap,  and  the  following  applied : 

V'.    Acid.  Borici,  3j. 

Cocain.  Hydrochloratis,  3j. 

Lanolini,  ^j. 
M.  (^Vn.) 

Tar : — Ointments  applied  and  covered  with  dusting 
powder  are  of  especial  value  in  adults.     (Hy.) 

A  formula  for  a  tar  ointment  to  be  preceded  by  a  5 
per  cent,  application  of  cocaine  for  the  relief  of  the 
pain  is  as  follows : 


230         DIGEST   OF  EXTERNAL  THERAPEUTICS. 

9.    Picis  Liquidae,  3J. 

Medullse  Bovis,  ^vj. 

Cerse  Albse,  3J. 

Ol.  Rosse,  M.v. 
M.  (Vn.) 

Salicylic  Acid: — A  solution  of  15  grains  in  1  ounce 
of  flexible  collodion  is  often  followed  by  good  results. 

(Ja.) 

Hot  \Vater : — Bulkley  recommends  the  following: 
A  soft  cloth  dipped  in  water  as  hot  as  can  be  borne 
is  pressed  against  the  anal  region  for  a  minute,  re- 
peat the  application  three  times,  then  dry  and  apply 
the  following  ointment : 

1^.    zinc.  Oxidi,  3J. 

Pulv.  Amyli,  ^ij. 

Ung.  Picis  Liq.,  gij-iv. 

Ung.  Vaselini  Plumbici,  q.  s.  ad  ,^j. 
M. 
Before  using  the  fomentation  the  salve  is  made  ready  for  applica- 
tion by  spreading  it  on  lint. 

Duhring  uses  this  formula : 

9;.    Sulphur.  Praecipitati,  9ij. 

Naphtholi,  9j. 

Morph.  Sulphatis,       *  gr-ij- 

Zinc.  Carbonatis,  3j- 

Ung.  Aq.  Rosae,  gj. 

M. 

Carbolic  Acid  : — 20  per  cent,  in  almond  oil  rubbed 
in  ^nth  the  fingers  at  night  will  give  relief  even  when 
the  surface  is  fissured  and  abraded.     (Vn.) 

Rubber  Sheeting  or  protective  worn  in  the  form  of 
a  T  bandage  for  a  few^  days  w^ill  be  usefiil  w^hen  there 
is  much  infiltration.     (Ja.) 

Penciling  with  solutions  of  Nitrate  of  Silver,  and 


ECZEMA.  231 

applications  of  Potash  or  Coal  Tar.  may  also  be  em- 
ployed in  the  same  condition. 

Scarification  is  sometimes  effective  in  exceedingly 
obstinate  cases.     (B.  H.) 

The  parts  should  be  kept  as  clean  as  possible,  and 
the  fold  of  the  nates  separated  by  a  layer  of  lint. 

Eczema  of  the  Auditory  Meatus. 

Accumulations  of  wax  and  epithelium  should  be  re- 
moved by  sj^ringing  with  warm  solutions  of  Borax 
or  Carbonate  of  Soda  as  directed  under  the  head  of 
Impacted  Cerumen. 

Hydrogen  Peroxide  : — Recommended  for  cleansing. 
(T.,  98.) 

Boric  Acid,  b\^  insufflation.  Tannic  Acid  3J-3J,  or 
Nitrate  of  Silver  gr.  x-xx-gj  applied  by  means  of 
absorbent  cotton  on  a  probe,  w^ith  the  ear  properly 
illuminated,  are  useful  to  allay  the  itching.     (Bac.) 

Potassa  : — When  there  is  much  infiltration,  a  solu- 
tion of  10  grains  to  the  ounce  may  be  applied  wdth  a 
camel's  hair  brush  carefully  stripped  of  all  excess  be- 
fore introduction,  so  that  not  a  drop  will  run  down 
to  the  tympanum.     (Vn.) 

Cold  Cream  : — Is  useful  after  application  of  nitrate 
of  silver  if  there  is  much  oozing.     (Bac.) 

Ichthyol: — 25  per  cent,  ointments  in  acute  and  ery- 
sipelatous varieties.     (T.,  98.) 

Calomel : — Gr.  xx-xl-§j  as  an  ointment  in  dry  and 
irritable  forms.     (T.,  98.) 

The  following  acts  well : 

9;.    Acid.  Salicylici,  gr.j. 

Tr.  Benzoini,  gtt.  ij 

Ung.  Aq.  Rosae,  3J- 

M.  (Bac.) 


232  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Hydrarg.  Oxid.  Flav.  or  Resorcin: — 2  to  5  per  cent. 
ointments  in  sluggish  cases.     (T.,  98.) 

Acetum  Cantharidis  :  —  Applied  with  caution  is 
sometimes  effective.     (Bac.) 

The  following  has  been  suggested  by  Van  Harlin- 
gen  for  the  patient  to  use  during  the  intervals  of 
treatment  by  the  surgeon : 

9;.    Acid.  Carbolici  (crys. ), 

Zinc.  Sulphatis,  aa  gr.  xij. 

Glycerini,  S^ij- 

Aq.  Rosse,  ad  ,^xij. 

M. 

Sig.     Sj'ringe  the  ear  once  or  twice  a  day. 

Eczema  of  the  Beard. 

In  the  acute  pustular  variety  soothing  applica- 
tions are  indicated.  Carbolized  Oil,  Lime  ^A^ater  or 
Diluted  Black  W^ash  may  be  used  for  bathing  the 
affected  parts,  after  which  Cold  Cream  or  Vaseline 
may  be  applied.  The  hairs  should  be  closely  clipped, 
and  as  soon  as  the  acute  stage  has  passed,  daily 
shaving  should  be  required,  or  shaving  at  least  every 
other  day. 

Ung.  Vaselini  Plumbici : — Spread  on  muslin  should 
be  applied  after  shaving. 

Epilation  of  hairs  situated  in  the  pustules  should 
be  practiced  when  the  disease  has  become  chronic, 
followed  by  ointments. 

The  following  is  for  use  in  the  squamous  form : 

9;.    Hydrarg.  Ammoniat.,  gr.  xx. 

Lanolini,  §j. 

M.  (Ja.) 

For  chronic  varieties  (Rosenthal's  paste): 


ECZEMA.  233 


Acid.  Tannici, 

3J- 

Sulphur.  Prsecipitati, 

3ij- 

Zinc.  Oxidi, 

Amyli, 

aa  gr.  cl. 

Vaselini, 

gr.  clx. 

(B.  H.) 

^. 


M. 

Sulphur: — A  1  to  2  per  cent,  ointment  is  recom- 
mended by  Crocker. 

Eczema  of  the  Breast  and  Nipple. 

Wash  the  nipple  carefully,  using  as  little  water  as 
possible,  dry  with  a  soft  handkerchief  and  dress  with 
Zinc  or  Diachylon  Ointment.  It  is  obvious  that  this 
must  be  removed  before  nursing.     (Ja. ) 

Rubber  nipples  are  useful  to  wear  while  nursing 
w^hen  there  are  cracks  in  the  nipple.  After  drying, 
painting  with  Tr.  Benzoin  Comp.  or  Tr.  Myrrh  is 
often  effective.     (B.  H.) 

Lister's  ointment  for  fissures : 

p.    Acid.  Borici, 

Cerse  Albae,  aa  gr.  xv. 

Paraffini, 

01.  Amygdalae,  aa  gss. 

M. 
Sig.     Wash  the  nipple  with  borax  1-25  and  apply  on  muslin. 

Borax: — Useful  as  an  ointment  as  well  as  for 
cleansing. 

Thymol  with  Powdered  Zinc  Oleate,  a  grain  to 
the  ounce,  for  eczema  under  the  breasts.     (Ja.) 

Nitrate  of  Silver: — In  solution  of  gr.  xvj— Ij  or  the 
crayon  for  touching  the  cracks.     (B.  H.) 

No  poisonous  application  should  be  used. 


234  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Eczema  of  the  Bars. 

When  the  disease  is  situated  on  the  outer  part  of 
the  ear,  the  same  general  line  of  treatment  mentioned 
for  the  disease  in  other  localities  is  for  the  most  part 
applicable.  In  applying  the  dressing  care  should  be 
observed  to  cover  every  part  and  furrow.  A  pledget 
of  lint  should  be  placed  behind  the  ear,  so  that  it  will 
be  constant^  kept  separated  from  the  side  of  the 
head  while  sleeping.  Lotio  Nigra  ma3^  be  used  first. 
Compound  Oxide  of  Zinc  Lotion  also  of  service. 
These  remedies  are  specially  indicated  in  the  vesicu- 
lar form. 

Zinc  Oxide  Ointment: — According  to  Bacon,  is 
usually  all  that  is  required. 

Diachylon  Ointment: — Suitable  to  some  cases. 
(Bac.) 

Ung.  Vaselini  Plumbici: — Containing  1  per  cent, 
of  carbolic  acid,  if  there  is  much  itching  in  subacute 
and  chronic  conditions.     (B.  H.) 

Salicylic  Acid  : — A  5  per  cent,  solution  w^hen  there 
is  much  infiltration  will  quickly  reduce  it.     (B.  H.) 

Sapo  Viridis  : — When  there  is  a  deep  crack  of  long 
standing  behind  the  ears,  may  be  rubbed  in  briskly 
and  followed  by  tar  or  calomel  ointment  3J— §j ,  or  by 
equal  parts  of  pix  liquida  and  ung.  zinc,  oxidi.  (Hy.) 

Nitrate  of  Silver: — Gr.  v— x-^j  painted  on  in  the 
moist  forms.     (T.,  98.) 

The  ear  may  be  covered  during  the  day  \vith  a 
linen  bag  made  like  a  little  ear  muff. 

Lead  and  Opium  Lotion: — This  familiar  remedy 
or  the  following  of  a  similar  nature  will  prove  useful 
in  the  acute  stage : 


ECZEMA 

- 

¥fc. 

lyiq.  Plumb. 

Subacetatis, 

3ij- 

Bismuth.  Subnitratis, 

gss. 

Morphinae, 

gr.ij 

Glycerini, 

5j. 

Aq.  Rosae, 

q- 

s.  ad 

Sviij. 

M. 

Sig 

.     Shake  well 

before  using. 

(Bn.) 

235 


Eczema,   of  the  Eyelids. 

Weaker  applications  are  to  be  employed  than  are 
used  on  other  parts.  Glycerite  of  Starch,  Diachylon 
Ointment,  Oxide  of  Zinc,  or  Acetate  of  Lead  cerates, 
or  dusting  powders  of  Starch  alone,  or  mixed  with 
powdered  Oxide  of  Zinc  in  the  proportion  of  1  of 
the  latter  to  3  or  4  of  the  former,  should  be  used  in 
the  acute  varieties.     (N.  O.) 

Nitrate  of  Mercury: — The  officinal  ointment  diluted 
with  3  to  6  parts  of  cold  cream,  or  the  Red  Oxide  of 
Mercury,  10  grains,  to  cold  cream  1  ounce,  form  very 
useful  applications  for  mild  cases.     (Vn.) 

Aristol: — Has  been  highly  praised.  (N.  O.)  Anoint- 
ment of  5  grains  to  1  drachm  of  cosmoline  has  been 
found  effective. 

The  follow^ing  is  said  to  be  excellent : 


^.    Acid.  Salicylici, 

gr.  X, 

Ung.  Hydrarg.  Oxid.  Rub., 

3j. 

Ung.  Aq.  Rosae, 

5vj. 

M. 

(Ja.) 

Hydrarg.  Oxid.  Flav.: — Gr.  ss-iv,  vaseline  3J,  some- 
times known  as  Pagenstecher's  ointment;  it  may  be 
worked  in  over  the  eyelids.     (Al.) 

For  severe  cases  the  eyelashes  should  be  extracted, 
the  edges  of  the  lids  carefully  dried  and  touched  with 
a  camel's  hair  brush  moistened  with  a  solution  of 
Caustic  Potassa  gr.  x-^.    This  application  should 


236    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

be  wiped  away  immediately  and  cold  water  applied. 
Applications  may  be  made  daily  until  infiltration,  ex- 
udation and  itching  are  relieved,  when  a  stimulating 
ointment  such  as  the  Yellow  Oxide  of  Mercury  as 
above  may  be  used.     (Vn.) 

Eczema  of  the  Face. 

Crusts  when  present  should  be  removed  by  soak- 
ing in  Olive  Oil  or  the  Ung.  Vaselini  Plumbici  ap- 
plied with  strips  of  muslin.     (Hd.) 

Black  W^ash  and  Lime  'Water  are  of  decided  bene- 
fit.     (Hy.) 

Soothing  applications  should  be  employed  such  as 
the  foUow^ing,  w^hich  are  indicated  in  the  erythema- 
tous variety : 


ffc. 

Zinc.  Oxidi, 

Sss. 

Pulv.  Calaminae  Prseparatae, 

9iv. 

Glycerini, 

3J. 

Aq.  Calcis, 

3vij. 

M. 

Or, 

9^. 

Zinc.  Oxidi, 

§ss. 

Mucilag.  Acacise, 

3j- 

Emul.  Amygdalae, 

lij- 

Aq.  Rosae, 

ad  |iv. 

M.  (Hd.) 

The  following  ointment  is  described  as  of  great 
general  utility : 

ffc.    Zinc.  Oxidi,  3J. 

Pulv.  Amyli,  gij. 

Ung.  Picis  Liq.,  3J-iJ- 

Ung.  Vaselini  Plumbici,  q.  s.  ad  5  j. 

M.  (B.  H.) 
Sig.     Spread  on  muslin  and  retain  in  position  with  a  linen 
mask. 


ECZEMA.  237 

Squires'  Glycerole:  —  This  preparalion  is  as  fol- 
lows : 

9^.    Glycerit.  Plumbi  Snbacetatis,  ^ss. 

Ung.  Aq.  Rosae,  |j. 

Cerse  Albse,  q.  s. 
M.  (Hd.) 

The  following  called  Pro  van's  Paste  is  for  protect- 
ing the  parts  when  the  patient  desires  to  remove  the 
applications  and  go  out : 

Jfc.    Tragacanthse, 

Glycerini,  aa  ^ss. 

Sod.  Biboratis,  ^ss. 

Aq.  Destill,,  q.  s. 

M.  (Hd.) 

This  forms  a  thin  varnish  which  protects  the  skin 
from  the  air  and  which  can  be  easily  washed  off. 

Zinc  Oleate : — As  a  dusting  powder  for  protection 
after  the  use  of  pastes.     (Hd.) 

Acetanilid:— With  cold  cream,  9ij-iij-ij.    (T.,  98.) 

Carbolic  Acid: — Especially  useful  for  the  itching; 
may  be  used  when  the  disease  is  at  its  height : 

Jpfc,    Acid.  Carbolici,  .^iij- 

Glycerini,  gj. 

Lotio.  Nigrse.  Oj. 

M.  (Vn.) 

Diachylon  salve  on  mull  useful  for  chronic  eczema 
of  the  forehead.     (Hd.) 

Liq.  Carbonis  Detergens: — 1  part  to  8  of  water  or 
stronger  is  excellent.     (Vn.) 

When  ointments  agree  well  the  following  w^ill  be 
found  satisfactory : 

9;.    Picis  Liquidae,  ^ss-jj, 

Ung.  Aq.,  Rosse,       -  |j. 

M.  (Vn.) 


238  DIGEST    OF   EXTERNAL   THERAPEUTICS. 

Salicylic  Acid  Plaster :— 5  per  cent,  in  chronic  cases 
is  of  great  value:  (Hd.) 
For  the  healing  of  cracks  and  fissures : 


9. 

Ol.  Cadini, 

33- 

Liq.  Guttse  Perchae  seu  Collodii, 

SJ- 

M. 

Eczema  of  the  Genitals. 

The  parts  should  be  kept  separated  by  la^^ers  of 
linen,  and  in  the  case  of  males  the  genitalia  should  be 
wrapped  in  fine  soft  linens.  In  acute  cases  soothing 
remedies  should  be  employed,  such  as  Zinc  and  Cala- 
mine, Lead  "Water,  Black  W^ash,  and  Lotions  of 
Grindelia. 

Medicated  Baths: — In  acute  and  superficial  forms 
these  will  give  relief.  A  bath  may  be  prepared  as  fol- 
lows: Potass,  carb.,  §iv;  sod.  bicarb.,  gij  ;  pulv.  bor- 
acis,  §ij.  Mix,  dissolve  in  a  quart  of  water  and  add 
4  to  6  ounces  of  dry  starch ;  this  is  to  be  well  stirred 
through  the  w^ater,  then  6  to  8  ounces  of  glycerine 
added,  and  the  whole  mixed  w^ith  30  gallons  of 
warm  water.  The  patient  is  to  remain  in  the  bath 
15  to  20  minutes;  on  removal  dry  thoroughly  and 
dust  on  Bismuth  Subnitrate,  or  apply  some  bland 
ointment.     (Vn.) 

When  the  disease  is  chronic,  and  there  is  much  infil- 
tration with  scaling,  more  stimulating  treatment  is 
required,  such  as  the  following:  Green  Soap  wnth 
friction,  or  Salicylic  Acid  in  Alcohol  1  drachm  to  4 
ounces,  afterward  applying  Ung.  Vaselini  Plumbici, 
or  Salicylic  Acid  Plaster  5  per  cent,  strapped  on, 
Vleminckx's  Solution,  pure  or  diluted,  Wilkinson's 
Ointment,  or  painting  with  Caustic  Potash,  gr. 
xx-.^.     (B.H.) 


ECZEMA.  239 

For  the  itching : 

|fc.    Acid.  Carbolici,  3iij- 

Glycerini,  5J. 

Aq.  Destill.,  Oj. 

M. 

This  is  particularly  useful  in  females,  and  is  best 
preceded  by  applications  of  hot  water. 

Nitrate  of  Silver; — A  solution  in  nitrous  spirits  of 
ether  painted  on  is  useful  for  itching  of  the  scrotum. 
(Vn.) 

Lead  Liniment  forms  a  good  application.     (F.) 

For  eczema  of  the  vulva  the  follow^ing  is  com- 
mended :  Bran  Water  with  Boric  Acid  during  at- 
tack; in  the  intervals  Salicylic  Acid  Paste,  or  Car- 
bolic Acid  Lotion  1  part,  Balsam  Peru  4  parts,  oil 
of  Sweet  Almonds  400  parts;  dusting  powders  may 
be  freely  used.  Sitz  Baths  morning  and  evening.  (T., 
97.) 

Eczema  of  the  Hands  and  Feet. 

Calamine  and  Zinc  Lotion  alone,  or  with  Carbolic 
Acid,  5  to  10  drops  to  each  ounce  of  lotion,  affords 
relief  to  the  acute  vesicular  variety.     (B.  H.) 

Zinc  and  Tar; — Useful  after  the  disappearance  of 
the  more  acute  symptoms,  which  leave  the  parts  red 
and  somewhat  scaly,  viz.: 

9;.    Ung.  Picis  lyiq.,  ^ij. 

Zinc.  Oxidi,  3j. 

Ung.  Aq.  Rosse,  ^vj. 
M. 

In  subacute  and  papular  eczema : 


240  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


9?.    Bismuth.  Subnitratis, 

3iv. 

Zinc.  Oxidi, 

3i- 

Pulv.  Amyli, 

3ij- 

Acid.  Carbolici, 

M.x-xv. 

Vaselini, 

SJ. 

M. 

(B.  H.) 

Litharge, 

10  parts. 

Glycerine, 

30  parts. 

Starch, 

10  parts. 

Vinegar, 

60  parts. 

To  be  reduced  by  boiling  to  80  parts. 

(T., 

,98.) 

Green  Soap: — In  chronic  cases  when  there  is  homy- 
thickening  of  the  palms,  more  vigorous  treatment  is 
required.  Green  soap  spread  on  cloths  covered  wath 
a  rubber  bandage  may  be  applied  and  retained  night 
and  day  until  the  epidermis  is  softened  and  reduced 
in  thickness,  then  stimulating  ointments  of  tar  and 
sulphur  should  be  used.     (Vn.) 

Caustic  Potash: — Same  indications  as  for  green 
soap.  20  to  40  per  cent,  solutions  applied  by  the 
physician  himself;  the  hands  should  be  first  soaked 
inwrater  as  hot  as  can  be  touched,  then  a  mop  dipped 
into  the  solution  should  be  rubbed  on  the  parts.  If 
the  burning  is  considerable,  wash  with  cold  water 
and  apply  the  following : 

^.    Hydrarg.  Ammoniat.,  9j. 

Adipis,  5ss. 

Sevi  Benzoiati,  3ij  Bj- 

01.  Amygdalae  Dulcis,  M.x. 

Ung.  Petrolei,  ad  5vj. 
M. 

The  above  is  to  be  applied  on  cloths  and  covered 
"with  wax  paper.  This  treatment  may  be  employed 
daily  until  the  cracks  and  fissures  heal  and  the  skin 


ECZEMA.  24-1 

assumes  a  healthy  appearance.  Then  the  potassa  is 
discontinued  and  weak  tar  ointment  appUed,  3J— 5j. 
(Vn.) 

Salicylated  Plasters: — For  softening  the  homy 
epidermis  have  a  Yer3^  good  effect ;  the^^  are  moulded 
to  the  skin  and  allowed  to  remain  on  for  from 
twenty-four  hours  to  several  days,  when  they  be- 
come loose.  The  horny  epidermis  is  scraped  away 
and  ointments  applied.     (Kap.) 

Gelanthum: — For  dry  eczema  with  marked  thick- 
ening, as  a  vehicle  for  Salicylic  Acid,  Ichthyol,  Re- 
sorcin,  Chrysarobin,  or  Tar  to  replace  ointments. 
It  is  more  agreeable.     (F.)    See  Acute  Eczema. 

Thymol  and  Zinc  Oleate  : — These  remedies,  mixed 
in  the  proportion  of  1  part  of  the  former  to  8  of  the 
latter,  form  a  powder  which  is  more  useful  than  oint- 
ments when  the  disease  is  situated  between  the  toes. 
(B.  H.) 

Eczema  of  the  Legs. 

All  forms  of  the  disease  may  occur  in  this  locality 
and  should  receive  the  treatment  as  suggested  under 
the  general  head  of  this  subject;  the  following  details, 
however,  are  deserving  of  special  attention : 

Green  Soap : — Applied  with  friction,  this  remedy 
gives  satisfactory'  results  in  eczema  rubrum;  after 
rubbing  on  briskh^  wash  off  the  soap  with  warm 
water,  dry  gently  and  apply  Ung.  Vaselini  Plumbici 
on  strips  of  muslin  placed  on  evenlj'-  and  carefully 
retained  by  a  rubber  bandage.     (B.  H.) 

Diachylon  Ointment: — This  is  excellent  in  moist 
varieties. 


17 


242  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

The  following  paste,  recommended  bj-  Unna,  gives 
satisfactory  results : 

^.    Kaolini, 

Ol.  I/ini,  aa  5yj- 

Zinc.  Oxidi, 

Liq.  Plumbi  Subacetatis,  aa  ,^ss. 

M. 

Sig.     To  be  painted  and  allowed  to  drj'  ;  then  bandage,  chang- 
ing every  twenty-four  hours. 

Ichthyol : — 2  per  cent,  solution  in  glycerine,  al- 
mond oil,  or  rose  \\'ater  applied  on  lint  or  covered 
with  layers  of  cotton,  followed  by  a  2  per  cent.  Zinc 
or  Diachylon  Ointment.     (Vn.) 

Glycerole  of  Lead  Subacetate  : — Dilutions  of  vari- 
ous strengths  are  emplo3'ed.  It  is  indicated  in  exten- 
sive chronic  eczema  rubrum  of  a  dusky  hue  accom- 
panied by  weeping,  varicose  veins  and  cedema  of  the 
subcutaneous  tissues.  It  is  also  used  for  palmar 
eczema.  (X.)  Solutions  of  15  to  30  grains  to  1  ounce 
are  recommended ;  saturated  strips  of  muslin  are 
carefully  applied,  covered  wdth  waxed  paper  and 
bandaged. 

Rubber  Bandages: — When  the  veins  are  varicose 
apply  a  rubber  bandage  directh-  to  the  skin,  remove 
at  night,  cleanse  and  disinfect,  then  dust  the  leg  with 
Starch  or  Boric  Acid.  The  bandage  should  be  used 
with  caution  lest  it  cut  the  surface  or  macerate  the 
tissue.     (Vn.) 

Salicylated  Soap  Plasters: — Most  useful  in  scaly 
conditions;  serviceable  in  eczema  rubrum,     (B.  H.) 

The  following  is  recommended  for  general  use  in 
chronic  forms:  Ung.  Zinci  Oxidi,  Ung.  Hydrarg., 
Ung.  Plumbi  Subacetatis,  equal  parts.    (T.,  96.) 

Massage  is  often  of  service  in  verj^  chronic  condi- 


ECZEMA.  243 

tions.  Before  employing,  wash  the  limb  with  some 
parasiticide  soap  and  follow  with  a  lotion  of  Bi- 
chloride of  Mercury,  1-1000,  or  a  saturated  solu- 
tion of  Boric  Acid.     (Vn.) 

Eczema   of  the  Lips. 

Cold  Cream,  Lanoline,  ^inc  Almond  Emulsion, 
Ung.  Vaselini  Plumbici  for  acute  types.  Thymol,  5 
grains,  with  Cold  Cream,  1  ounce;  Salicylic  Acid 
Plaster,  5  per  cent.,  in  chronic  lorms.  Tr.  Benzoin 
Comp.  or  Collodion  painted  on  serve  Avell,  giving 
relief  and  protection.     (B.  H.) 

Dilute  Phosphoric  Acid: — May  be  employed  as 
follows : 

9;.    Acid.  Phosphoric.  Dil., 

Glycerini, 

Syrupi,  aa  ^ss. 

M. 
Sig.     Apply  three  times  a  day.     (Vn. ) 

Nitrate  of  Silver  : — The  crayon  may  be  touched  to 
deep  cracks;  afterwards  apply  Benzoin. 

Ung.  Hydrarg.  Oxid.  Rub.: — A  minute  quantity 
of  a  strong  ointment,  40  to  60  grains  to  the  drachm, 
for  very  chronic  fissures  in  the  lips ;  the  fissure  is  torn 
open  and  the  ointment  applied  with  a  little  stick. 
(Vn.) 

Liq.  Plumbi  Subacetatis:  —  M.  xv-§j,  with  white 
vaseline.     (Ck.) 

Nasal  catarrh,  which  is  a  frequent  cause,  should 
receive  treatment. 

Eczema  of  the  Nails. 

Salicylated  Collodion: — Painted  on  the  infiltration 
around  the  nail,  followed  by  Ung.  Vaselini  Plumbici. 
(B.H.) 


244  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Tar  Ointment: — A  drachm  to  the  ounce.     (Vn.) 
Ung.   Diachylon: — Useful  when  there  is  much  ten- 
derness.    (Vn.) 

Salicylic  Acid: — The  salicylated  rubber  plaster 
during  the  day,  and  an  ointment  of  the  acid  with  tar 
ointment,  1  drachm  to  the  ounce,  when  the  parts  are 
tender.     (Vn.) 

Eczema  of  the  Nares. 

This  affection  is  often  associated  with  chronic 
rhinitis ;  when  such  is  the  case  the  first  effort  should 
be  directed  to  the  treatment  of  the  latter  condition. 
All  crusts  should  be  removed  by  soaking  in  Olive  Oil, 
w^hich  can  be  dropped  into  the  nose  or  applied  with 
a  camel's  hair  brush ;  when  thoroughly  softened  they 
can  be  easily  removed,  after  which  one  of  the  follow- 
ing may  be  used  with  good  effect:  Ung.  Hydrarg. 
Oxidi  Flav.;  Ung.  Plumbi  and  Vaseline,  equal  parts; 
Glyceritum  Plumbi  Subacetatis  and  Ung.  Aq.  Rosse, 
equal  parts.    (Hd.) 

Zinc  and  Red  Precipitate  Mull: — Small  rolls  of 
paper  covered  with  the  mull  and  inserted  up  the 
nostril  are  recommended  by  Unna. 

Eczema  of  the  Scalp. 

In  children  and  men  the  hair  should  be  cut  short, 
but  this  is  not  necessary  in  women.  If  crusts  are 
present  they  may  be  removed  bj^  Olive  Oil ;  saturate 
the  scalp,  cover  the  head  with  a  cap  and  wash  off  in 
the  morning;  repeat  if  necessary,  or  use  Starch  Com- 
presses to  the  scalp,  allowing  them  to  remain  on 
for  a  little  while,  or  Starch  and  Boric  Acid,  each  1 
drachm,  water,  1  pint.     (Vn.) 


ECZEMA.  245 

Sodium  Bicarbonate: — Very  useful  in  solution  ap- 
plied in  the  same  manner  for  removing  crusts  in  in- 
fantile variety.    The  following  is  recommended : 

^.    Sod.  Bicarbonatis, ,  3J. 

Liq.  Sod.  Chlorinatae,  .^j. 

Aq.  Destill.,  ^xij, 
M.  (Al.) 

Liq.  Potassae:— 1  part  to  8  to  12  of  olive  oil  for  re- 
moval of  crusts  in  children.     (Jac.) 

The  above  applications  prepare  the  scalp  for  more 
active  medicinal  agents. 

Lotio  Nigra  : — Alone  or  better  with  Aq.  Calais  for 
acute  inflammatory  conditions.  Apply  with  a 
sponge  for  ten  or  fifteen  minutes  and  follow  with 
an  ointment.    (Vn.) 

Ung.  Vaselini  Plumbici:— Spread  on  strips  of 
muslin  and  retained  by  a  cap,  useful  when  the  hair  is 
short ;  and  in  acute  forms  in  young  infants.     (B.  H.) 

Carbolic  Acid: — Solutions  are  useful.  Same  indi- 
cations as  for  black  wash.     (Vn.) 

The  following  ointments  are  recommended  by  Van 
Harlingen : 

^.    Bismuth.  Subnitratis, 

Ung.  Petrolii,  partes  equales. 

M. 

Or, 

9;.    Hydrarg.  Ammoniat.,  gr.  x-xx. 

Ung.  Petrolii,  ^j. 

M. 

The  latter  is  more  stimulating,  and  indicated  in 
subacute  and  chronic  forms  as  a  substitute  for  tar 
preparations : 

Jacobi  recommends  after  the  removal  of  crusts: 


246  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

Bismuth  Subnitrate,  5  parts,  Vaseline,  Zinc  Oxide 
Ointment,  each  20  parts,  or  Hebra's  Diachlyon  Oint- 
ment spread  on  linen  and  worn  for  days  or  weeks. 

Salicylic  Acid  or  Sulphur: — 20  to  30  grains  of 
either  to  the  ounce  often  has  striking  effects  after 
subsidence  of  acute  symptoms,  or  when  the  condition 
from  the  onset  has  been  more  of  a  moist  exudation. 
(B.  H.) 

Salicylic  Sulphur  Ointment: — Nothing,  says  Hard- 
away,  is  so  useful  in  the  dry,  scaly,  chronic  forms  of 
the  disease ;  the  following  combination  being  recom- 
mended : 

¥fc.    Acid.  Salicylici,  9j--3ss. 

Sulphur.  Praecipitati,  3J. 

Vaselini,  ^j. 

Ol.  Limonis,  q.  s. 

Sig.     Rub  in  scalp  thoroughly  once  or  twice  daily. 

The  following  is  recommended  as  the  best  applica- 
tion after  the  more  acute  symptoms  have  disap- 
peared : 

^.    Ung.  Picis  Liq.,  3j-ij. 

Zinc.  Oxidi,  3j- 

Ung.  Aq.  Rosse,  gj. 

M. 

Sig"     Spread  on  muslin  if  there  is  no  hair;  otherwise  smear  on 
gently  with  the  fingers.     (B.  H. ) 

Nitrate  of  Silver:— 1  to  2  per  cent,  solutions  ap- 
plied daily,  or  at  longer  intervals,  followed  bj-  salves. 
(Duh.) 

Resorcin: — 5  per  cent,  as  a  salve  or  lotion  with 
glycerine  or  alcohol  is  of  benefit.     (B.  H.) 

Balsam  Peru: — Useful  in  children  when  the  healing 
process  is  slow.     (Jac. ) 


ECZEMA.  247 

Tar : — Used  when  still  stronger  stimulation  is  nec- 
essary, viz.: 

9:.    Ol.  Cadini,  ,^ss. 

Ol.  Olivse,  Ij. 

M.  (B.  H.) 

For  adults  when  there  is  intense  pruritus. 
Or, 


9. 

M. 

Picis  L,iquidae, 
Vaselini, 

3J- 

(Vn.) 

Tar  and  mercury  together 
viz.: 

often  act  beneficially, 

M. 

Hydrarg.  Atnmoniat., 
I/iq.  Carbonis  Deterg., 
Lanolini, 

9j. 

^B.  H.) 

Tannic  Acid : — When  there 

is  a  tendency 

to  greasi- 

ness. 
The 

following  ointment  is  useful : 

5fc. 

M. 

Acid.  Tannici, 
Acid.  Carbolici, 
Cerat.  Galeni, 

3si- 
M.v 

-X. 

(B.  H.) 

Calomel  and  "White  Precipitate  : — These  remedies 
may  be  substituted  for  tar  with  the  same  indica- 
tions, when  the  latter  is  not  well  tolerated.  They 
may  be  used  alone  in  the  strength  of  from  20  to  60 
grains  to  the  ounce.  Calomel  ointment  has  a  stimu- 
lating and  drying  effect  and  is  useful  when  there  is 
discharge. 

Glycerine  and  Alcohol: — May  be  substituted  in  the 
various  preparations  for  vaseline  when  the  hair  is 
long.    All  ointments  should  be  soft. 


248  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


Universal  Eczema. 

The  patient  should  be  kept  in  bed.  The  most  effect- 
ive appHcations  are  lotions  and  oils,  viz.:  Carron 
Oil,  Cotton  Seed  Oil,  and  Carbolic  Acid,  1  part  of 
the  acid  to  60  of  the  oil,  or  anoint  the  body  with 
Vaseline  and  apply  Starch  Powder,  or  Salicylic 
Acid  in  Olive  Oil,  1  part  to  30.     (Ja.) 

Bulkley  recommends  after  drying  the  skin : 

9.    Acid.  Carbolici,  9j-3j' 

Amyl.  Glyceriti,  giv. 

Macintosh's  cream  is  an  excellent  preparation. 
Its  composition  is  as  follows : 

9^.    Bismuth.  Subnitratis,  5^]' 

Zinc.  Oxidi,  5^8. 

Glycerini,  5iss. 

Acid.  Carbolici,  M.xx-xxx. 

M. 

Sig.     Apply  with  a  brush.  The  carbolic  acid  may  be  omitted 
or  reduced  for  universal  application.     (B.  H.) 

Alkaline  Baths  : — Followed  hj  one  of  the  oily  ap- 
plications, after  gently  drying  the  skin,  are  effective. 
The  bath,  temperature  of  which  should  be  98°,  should 
continue  for  ten  or  fifteen  minutes.  The  best  way  to 
dry  the  body  is  to  wrap  the  patient  in  a  warm  sheet 
and  pat  the  skin  dry.  After  replacing  the  patient 
in  bed  cover  him  with  dusting  powders  and  wrap 
him  in  a  sheet. 

When  the  skin  is  thick  and  scaly,  Wilkinson's 
Ointment  10  per  cent.,  pigments  of  Salicylic  Acid  or 
Chrysarobin  in  Traumaticine,  Sulphate  of  Zinc,  .^ij- 
iv— Oj,  and  the  following  solution  of  Lead  and  Tar  ; 


ECZEMA.  249 

V^.    Liq.  Carbon.  Deterg.,  ^ij. 

I,iq.  Plunibi  Subacetatis,  ^ij. 

Aq.  Destill.,  Svi^j- 
M.  (B.  H.) 

Solutions  of  Menthol  and  Carbolic  will  prove  use- 
ful for  the  relief  of  the  pruritus,  see  that  subject. 


ECZEMA  SEBORRHCEICUM. 

The  principal  treatment  is  local  and  most  cases, 
even  those  of  long  standing,  wall  be  found  amenable 
to  mild  measures. 

Sulphur : — One  of  the  best  remedies  for  the  moist 
variety. 

Among  its  combinations  the  following  will  prove 
useful : 

9;.    Sulphur,  prsecipitati,  5^~j- 

Zinc.  Oxidi,  gr.  xv-1. 
Lanolini, 

Ol.  Amygdalae,  aa  ^iij- 

Ext.  Violet.,  q.  s.  M. 

M.  (Brocq. ) 

Resorcin  : — One  of  the  most  effective  remedies  in 
solution  and  ointments.  (F.)  For  the  hairy  parts  a 
solution  in  alcohol  and  water  is  as  follows : 

5ss-j. 
aa  5^ss. 


gr.  x-xxx. 

:b.  H.) 


tt. 

Resorcini, 

Spts.  Vini  Rect., 

Aq.  Destill., 

M. 

Or, 

ffc. 

Resorcini, 

Ung.  Aq.  Rosae, 

M. 

Sig 

.     Apply  twice  daily 

250  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

For  irritable  forms  in  the  folds  of  the  skin,  and  for 
the  moist  variet}',  the  following  maj"  be  used  with 
good  effect : 

1^.    Resorcini,  gr.  xij. 

Zinc.  Oxidi,  ^ss-^j. 

Cerat.  Simp.,  3 v. 
M. 

For  the  disease  in  children  the  following  is  espe- 
cially recommended :  After  removal  of  crusts  apply 
compresses  soaked  in  resorcin,  6—1000.  At  night 
apply  an  ointment  of  1  part  of  Balsam  of  Peru  and 
30  of  vaseline.     (T.,  96.) 

Sulphur  and  resorcin  may  be  combined  with  ad- 
vantage. A  3  to  6  or  10  per  cent,  salve  of  the  former 
with  1  to  3  per  cent,  of  resorcin  may  be  employed. 

The  following  constitutes  a  useful  formula : 

^e.    Resorcini,  gr.  v-x. 

Sulphur.  Praecipitati,  gr.  xv-  3  ss. 

Ung.  Aquae  Rosae,  5j. 

M.  (B.  HO 

Boric  Acid  or  Salicylic  Acid  may  sometimes  be 
substituted  for  resorcin,  the  former  in  3  to  5  per 
cent,  strength  and  the  latter  in  1  to  2  per  cent. 

Calomel:  —  The  following  combination  is  often 
used : 

^.    Hydrarg.  Chlorid.  Mitis,  gr.  viij-xv. 

Zinc.  Oxidi,  3ss-j. 

Petrolati,  3  v. 

M.  (Vn. ) 

Chrysarobin,  Anthrarobin,  and  Pyrogallic  Acid  in 
the  strength  of  2  to  10  per  cent,  ointments  or  lotions 
may  be  used  in  those  cases  marked  by  scaliness  and 
incrustation  (Ja.),  and  in  those  resembling  psoriasis. 
(B.H.) 


EMPHYSEMA.  251 

Oil  of  Cade  and  Ichthyol  ointments  are  beneficial. 
Ichthyol  Soap  should  be  used  for  general  cleansing, 
and  Sublimate  Soap  for  the  scalp. 


EMPHYSEMA. 

S^'stematic  long-continued  practices  in  Expiratory 
Exercise  are  recommended.     (T.,  97.) 

Condensed  Air  Baths:— Often  afford  marked  relief, 
but  are  contra-indicated  when  there  are  cardiac 
lesions  and  w^hen  the  age  of  the  patient  is  over  50. 
(F.) 

In  regard  to  the  use  of  this  agent  Dr.  J.  K.  Fowler 
writes  as  follows : 

I  have  given  a  prolonged  trial  at  the  Brompton 
Hospital  of  the  use  of  the  compressed  air  bath  in  the 
treatment  of  emphysema  associated  with  bronchitis, 
and  am  able  to  support  the  favorable  opinions  which 
have  been  expressed  as  to  its  great  value.  Patients 
almost  invariably'  state  that  they  breathe  more 
freelj^  w^hile  in  the  bath,  and  after  a  considerable 
number  of  baths  (from  twenty  to  thirty  or  more) 
have  been  taken  this  feeling  becomes  continuous, 
and  has  remained  while  the  patients  have  been  under 
treatment.  In  addition  to  the  greater  freedom  of 
respiration  and  increased  capacity  for  excretion,  the 
cough  becomes  less  frequent,  and  the  quantity  of  ex- 
pectoration is  reduced. 

In  a  healthy  person  the  effect  on  the  respiratory 
organs  of  submitting  the  body  as  a  whole  to  air 
gradually  condensed  to  the  extent  of  three-sevenths 
or  one-half  an  atmosphere  is  to  cause  diminished  fre- 


252  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

quency  of  respiration,  enlargement  of  the  lungs,  in- 
crease of  the  vital  capacity,  and  probabh^  also  an 
increase  in  the  amount  of  the  oxygen  absorbed.  In 
the  subject  of  emphj-sema,  however,  the  effect  of  the 
bath  is  to  cause  a  reduction  in  the  size  of  the  chest, 
as  ascertained  by  measurement  of  the  circumference ; 
and  also  in  the  amount  of  distension  of  the  lungs,  as 
proved  by  the  reappearance  of  dulness  in  the  pras- 
cordial  and  hepatic  regions.  The  diaphragm  is  raised 
instead  of  being  lowered,  and  epigastric  pulsation 
may  be  replaced  by  an  impulse  more  nearly  in  the 
normal  situation  of  the  apex  beat  of  the  heart. 

It  appears  probable  that  the  condensed  air  pene- 
trates into  parts  of  the  lungs  which  have  been  long 
unused  in  respiration,  and  in  -which  air  has  been,  so 
to  speak,  imprisoned  at  a  high  pressure ;  the  escape 
of  this  air  is  facilitated,  and  contraction  of  the  lung 
follows.     (Alb.) 

Ozone  Inhalations : — Have  been  used,  it  is  said, 
with  apparently  good  eifect.     (F.) 

Oxygen  Inhalations:  —  Sometimes  prove  useful. 
(Gn.) 

Treatment  of  \Valdenburg: — This  consists  of  in- 
spiring compressed  air  and  expiring  into  rarified  air. 
It  is  recommended  as  deser\nng  further  trial.     (An.) 

Forcible  Compression  of  the  Chest: — This  must 
usually  be  exercised  by  an  attendant.  An  apparatus 
is  described  by  Striimpell  for  this  purpose.  It  con- 
sists of  two  boards  fastened  behind  and  allowed  to 
project  in  front,  so  that  the  patient,  taking  hold  of 
the  projecting  ends,  can  compress  his  owm  chest  with 
each  expiration.  Compression  should  be  coincident 
with  each  expiratory  movement.     (Ty.) 


EMPYEMA.  253 


EMPYEMA. 

Local  treatment  is  surgical.  Pus  must  be  removed 
by  aspiration  or  incision. 

Aspiration  : — Adequate  for  the  majority  of  cases. 
(L.  T.)  It  may  be  employed  when  septic  symptoms 
are  not  urgent.  (W.)  Anaesthesia  is  condemned  as 
dangerous  (Sj.),  but  local  anaesthesia  in  the  form  of 
rhigoline  or  injections  of  cocaine  may  be  advantage- 
ously emplo\^ed.  It  is  advisable  to  make  an  explor- 
atory puncture  before  operating. 

Incision  and  Free  Drainage  : — The  incision  should 
be  from  two  to  three  inches  long,  and  a  large  sized 
drainage  tube  inserted  with  the  end  secured  wath  a 
safety  pin.  It  should  be  made  in  the  eighth  inter- 
costal space  a  little  back  of  the  axillary  line ;  the  skin 
and  muscles  are  gradually  divided  dow^n  to  the 
pleura,  which  is  then  incised.  Strict  antisepsis  should 
be  observed  in  all  details,  and  the  patient  should  be 
anaesthetized.     (Ger.) 

Exsection  of  the  Rib: — Recommended  for  free 
drainage,  removing  about  one  to  two  inches  of  the 
rib.  It  is  superior  to  simple  incision  on  account  of 
the  free  exit  which  it  affords,  allowing  the  large 
masses  of  fibrinous  pus  to  escape.  (L.  T.)  It  has 
also  been  recommended  for  children,  on  account  of 
the  smallness  of  the  space  between  the  ribs,  which 
produces  compression  of  the  drainage  tube.  (T.,  96.) 

Irrigation  -. — Formerly  thought  to  be  of  primary 
importance  and  absolutely  essential.  Many  recent 
v^riters,  how^ever,  are  beginning  to  regard  it  in  a 
somewhat  different  light.  All  agree  that  it  is  imper- 
ative when  the  pus  is  offensive.     (L.  T.) 


254  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Salicylic  Acid  3  per  cent,  or  Boric  Acid  saturated 
solution  of  sterilized  water  are  recommended  for  irri- 
gation of  the  cavity  after  removal  of  pus.     (L.  T.) 

Hydrogen  Peroxide  : — Diluted  one-half,  especially 
recommended  for  washing  out  the  cavity.     (Gn.). 

Pyoktanin  Blue  :— In  solution  1-1000  to  2000,  is 
well  adapted  for  irrigation,  being  non-poisonous. 
(Al.) 

Hydrarg.  Bichlorid.: — 1-5000  for  irrigation,  fol- 
lowed by  a  final  flushing  of  the  cavity  of  1—1000 ; 
great  care  should  be  observed  to  drain  off  all  residue 
of  this  solution  by  turning  the  patient  on  the  side. 
(Ger.)  This  agent  is  recommended  hj  many  sur- 
geons. 

Tr.  Iodine : — The  undiluted  tincture,  Bartholov^ 
says,  maj^  be  thrown  into  the  cavity  without  risk 
and  with  great  benefit. 

The  Liq.  lodi  Comp.  in  the  proportion  of  1  part 
to  15  of  distilled  water  may  also  be  used  for  wash- 
ing out  the  cavity.     (B.) 

Styrone: — For  washing  cavity  after  exsection  of 
the  rib,  solutions  of  1—200  may  be  used,  gradually 
increasing  1—40.     (Al.) 

Iodoform  Gauze  Packing : — The  careful  introduc- 
tion, into  the  incision,  of  a  roll  of  iodoform  gauze  is 
preferred  by  some  to  irrigation,  except  ^when  the 
pus  is  offensive.  A  pad  of  oakum  covered  with  the 
gauze  forms  an  excellent  dressing  for  old  cases. 
(L.  T.) 

Syphon  of  Revilloid: — This  method  is  recommended 
for  intractable  cases  w^hich  are  incurable  by  the  so- 
called  classical  methods.  Favorable  results  have 
been  reported  in  cases  of  this  unpromising  nature.   It 


EMPYEMA.  255 

is  described  as  follows:  The  syphon  consists  of  a 
tube  of  black  rubber  which  is  inserted  into  the 
pleural  cavity ;  two  feet  from  the  proximal  end  is 
placed  a  bulb ;  the  tube  is  continued  for  three  or  four 
feet,  and  its  end  is  placed  in  a  receptacle  containing- 
an  antiseptic  solution — either  carbolic  acid  or  creo- 
lin — so  as  to  prevent  the  entrance  of  air.  The  proxi- 
mal end  is  retained  in  position  with  plaster.  If  there 
is  no  fistula,  an  incision  is  made  near  the  posterior 
axillary  line.  After  making  the  incision,  which 
should  be  large  enough  to  allow  the  free  escape  of 
pus,  the  syphon  is  introduced,  and  the  lips  of  the  in- 
cision hermetically  sealed  around  the  tube.  All  that 
is  necessary  now  is  careful  watchfulness  on  the  part 
of  the  surgeon.     (B.  M.  S.  J.,  11,  22,  94.) 

Estlander's  Operation: — Maybe  considered  in  old 
and  inveterate  cases  with  or  without  sinuses.    (Ger.) 

James'  Method  for  Expansion  of  the  Lungs: — This 
has  been  practiced  with  success.  The  patient  for  a 
certain  time  transfers  water  by  air  pressure  from  one 
bottle  to  another.  The  bottles  should  hold  about  a 
gallon  each,  and  by  an  arrangement  of  tubes  the 
patient  forces  the  water  from  one  bottle  to  another. 
The  strength  or  quantitj^  of  the  transfer  is  increased 
as  the  patient's  strength  progresses.  Thus  the  ex- 
pansion of  the  lung  is  systematically  practiced.  The 
abscess  cavity  is  gradually  closed,  partly  by  expan- 
sion of  the  lung  and  partly  by  the  falling  in  of  the 
chest  walls.     (An.) 


256  DIGEST   OF  EXTERNAL  THERAPEUTICS. 


ENCEPHALITIS,  MENINGITIS,  AND 
CEREBRAL    CONGESTION. 

Ice  Bags  and  Cold  Compresses  should  be  applied 
to  the  head,  and  the  patient  kept  in  bed  with  as 
little  physical  restraint  as  possible.     (Gn.) 

In  cerebral  congestion  with  much  mental  excite- 
ment, great  and  speedy  relief  may  frequently  be  ob- 
tained by  packing  the  legs  from  the  groin  to  the  leet 
inclusive  in  large  towels  which  have  been  wrung  out 
in  hot  mustard  v^ater.  The  towels  should  be  covered 
w^ith  blankets,  and  after  the  pack  the  limbs  should 
be  quickly  rubbed  with  tepid  damp  towels.     (Rd.) 


ENDOCARDITIS. 

ACUTE  ENDOCARDITIS. 

Ice  Bag: — Applied  over  the  region  of  the  heart 
affords  marked  amelioration  of  symptoms  in  en- 
docarditis from  acute  infectious  diseases,  the  pain 
and  palpitation  are  relieved  and  the  temperature 
lowered.  A  layer  of  flannel  should  be  placed  be- 
tween the  bag  and  the  skin,  otherwise  erythema  may 
appear.     (T.,  98.) 

Hot  Fomentations: — As  mustard  or  linseed  poul- 
tices, for  relief  of  pain  are  preferred  in  some  cases. 
(Bt.) 

Blisters: — These  are  often  beneficial  in  rheumatic 
forms.  Dr.  Caton,  of  Edinburgh,  recommends  the 
following  line  of  treatment  to  prevent  the  occurrence 


ENDOCARDITIS.  257 

of  valvular  disease  of  the  heart;   to  complete  the 
method  the  internal  remedies  are  also  mentioned : 

Protect  the  patient  from  exposure  to  cold  by  cloth- 
ing with  warm  woolen  garments  next  to  the  skin 
during  the  whole  of  the  acute  period,  and  insist  upon 
prolonged  absolute  rest.     In  the  way  of  medicines 
give  gentle  cholagogues  with  some  of  the  salicylate 
preparations.   Diet  should  be  light  and  simple.  When 
pain  fails  to  yield  to  this  treatment,  it  is  quickly  dis- 
pelled by  Da  vies'  method  of  treating  rheumatism  by 
the  application  of  small  blisters  to  the  joints.    Under 
this  treatment  82   or  83  per  cent,  of  his  cases  re- 
cover without  cardiac  complications.     In  the  arrest 
of  cardiac  valvular  disease,  when  once  developed,  the 
salicylates  were  found  to  be  of  little  or  no  benefit. 
When  the  cardiac  bruit  is  first  perceptible,  or  there 
occurs  a  muffling  of  the  first  sound  at  the  apex, 
Caton  applies  in  the  course  of  the  third,  fourth,  fifth, 
or  sixth  intercostal  nerves  small  blisters,  not  much 
larger  than  a  shilling,  in  succession,  one  at  a  time. 
The  patient  is  kept  in  bed  absolutely  recumbent,  and 
as  quiet  as  possible,  for  several  wrecks.     In  addition 
to  the  salicylates,  8  or  10  grain  doses  of  sodium 
iodide,   or  potassium  iodide,  are  given  three  times 
daily,  in  the  hope  that  it  may  help  to  absorb  inflam- 
matory products.     In  about  five-sevenths   of  these 
cases  the  bruit  vanishes,  and  the  patient  leaves  the 
hospital  with  a  sound  heart.    If  these  patients  have 
a  relapse,  or  a  second  attack  of  rheumatism  within 
a  few  months,   the  endocarditis  is  almost  sure  to 
return.    (E.  M.J. ,  4,  99.) 

CHRONIC  ENDOCARDITIS.    See  Valvular  Disease 
of  the  Heart. 

18 


258  DIGEST    OF   EXTERNAL   THERAPEUTICS. 


ENDOCERVICITIS    AND    CERVICITIS. 

ACUTE  ENDOCERVICITIS  AND  CERVICITIS. 

From  a  clinical  standpoint  these  conditions  do  not 
need  to  be  considered  separately  from  Acute  Endo- 
metritis and  Metritis. 

CHRONIC  ENDOCERVICITIS,  AND  CERVICITIS 
AND  EROSION 

Remove  the  plug  of  mucus  from  the  cervix  with 
cotton  on  an  applicator,  and  thoroughly  cleanse  be- 
fore using  local  remedial  agents. 

Tepid  Water  Douches: — For  cleanliness  unless  the 
hot  water  douche  is  used. 

Hot  'Water  Douches: — Large  quantities  of  very 
hot  w^ater  are  generally  employed,  w4th  good  effect^ 
but  at  the  sarhe  time  frequently  abused.     (Sw.) 

Iodine : — One  of  the  most  efffcacious  remedies,  indi- 
cated in  granular  degenerations  and  in  all  chronic 
conditions ;  contra-indicated  in  acute  inflammations. 
Apply  with  a  brush,  inserting  it  well  up  in  the  canal. 
Churchill's  iodine  should  be  used.     (Sv^.) 

The  following  is  recommended  when  there  is 
uterine  colic : 

Tr.  Iodine  and  Creosote  each,  3j- 

Glycerine,  3j. 

To  be  applied  on  tampons.      (Ch. ) 

Glycerine: — The  chief  agent  is  local  applications 
for  relief  of  congestion ;  used  largely  as  a  vehicle  for 
other  remedies,  as  well  as  for  its  local  depleting 
eifects. 


ENDOCERVICITIS   AND   CERVICITIS.  259 

Ichthyol: — Regarded  by  man^'^  as  one  of  the  most 
efficient  remedies ;  is  of  great  benefit  and  wide  range 
of  application.  It  is  used  in  various  strengths,  from 
5  to  50  per  cent,  in  glycerine,  sometimes  pure.     (F.) 

lodotannin  :  —  Packed  around  cervix  is  of  un- 
doubted value ;  alterative  and  astringent.     (B.) 

Carbolic  Acid: — As  a  disinfectant,  in  2  to  5  per 
cent,  solutions  for  douches;  also  as  a  mild  caustic 
and  a  stimulant  for  erosions.     (Sw.) 

Boroglyceride  : — One  of  the  most  valuable  applica- 
tions in  erosions  with  effusive  leucorrhoea  and  itch- 
ing of  the  parts.  Used  diluted  v^ith  twice  its  bulk  in 
glycerine  or  in  the  form  of  a  cerate. 

Calendula : — When  erosions  are  very  red  and  bleed 
easily,  this  remedy  may  be  used  with  good  effect  in 
varying  strengths ;  2  drachms  to  8  ounces  of  tepid 
w^ater  will  form  a  useful  douche.  Non-alcoholic  prep- 
arations are  preferable.     (M.  H.) 

Hydrastis: — Useful  in  powder,  tincture  or  cerate  in 
cases  attended  with  profiise  stringy  leucorrhoea. 
Equal  parts  of  the  extract  and  boroglycerine  very 
useful.     (Bt.) 

Hamamelis : — May  be  used  when  soothing  effects 
are  indicated,  as  in  erosions  that  are  sore  and  bleed- 
ing attended  with  venous  engorgement  and  piles; 
the  cerate  or  watery  extract  with  equal  parts  of 
glycerine,  as  an  application  or  injection.  Iodoform 
added  is  a  useful  adjuvant.     (Bt.) 

Iodoform: — A  very  effective  remedy.  Its  odor  may 
be  somewhat  counteracted  by  chloral  hydrate,  the 
tampon  being  soaked  in  the  following : 

9:.    lodofomii,  3j- 

Chloral.  Hydratis,  gr.  xx. 

Glycerini,  5j- 

M. 


260  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Sanguinaria: — Equal  parts  with  myrrh  and  hy- 
drastis  mixed  so  as  to  form  a  fine  powder,  applied  in 
the  usual  w^ay  with  wool  tampons,  form  a  most  ex- 
cellent and  effective  remedy.     (Sw.) 

Tannin : — For  astringent  effect  when  relaxation  of 
the  parts  is  prominent,  applied  on  glyceriene  tam- 
pons.    (M.  H.) 

Chromic  Acid: — A  50  per  cent,  aqueous  solution  in 
obstinate  cases  with  glairy  mucus  discharge,  espe- 
cially w^hen  a  laceration  exists.  Application  should 
be  made  only  once  a  week  in  exceptional  cases.  (Sw.) 

Zinc  Oleate  : — 1  part  with  iodoform  2  parts  as 
an  astringent  when  parts  are  excoriated  and  there 
is  a  fetid  leucorrhcea.     (F.) 

Thymol : — 1—1000  or  3000  on  glycerine  tampons. 
(F.) 

Zinc  Sozoiodate: — The  powder  gives  satisfactory 
results.     (Al.) 

Aristol : — When  the  consent  of  the  patient  cannot 
be  obtained  for  the  repair  of  a  lacerated  cervix,  a 
pencil  of  5  grains  of  aristol  made  up  with  gum 
arable  may  be  introduced  daily  and  retained  by  a 
tampon.  It  should  remain  in  for  tw^enty-four  hours ; 
then  the  cervical  canal  should  be  syringed  out  with 
the  following  solution,  using  2  tablespoonfuls  to  a 
quart  of  w^ater : 

Salicylic  Acid,  4  parts. 

Spts.  Lavender,  30  parts. 

Water,  450  parts. 

(T.,98.) 

The  aforementioned  remedies  are  nearly  all  to  be 
applied  on  glycerine  tampons.  For  the  use  of  injec- 
tions, see  Leucorrhoea. 


ENDOMETRITIS    AND   METRITIS.  261 

Lactic  Acid : — It  is  claimed  that  this  agent  is  a 
natural  antiseptic  for  the  vaginal  caYit3^  3  per  cent, 
solutions  destroy  the  bad  odor  and  greenish-yello-w 
color  of  the  leucorrhoea  and  diminish  the  amount  of 
secretion.  It  is  of  benefit  in  endometritis  and  endo- 
cervicitis.  Douches  of  1—35,  and  the  introduction  of 
tampons,  1  part  to  33  of  glycerine  every  eight  days 
with  daily  hot  w^ater  douches  in  the  intervals,  is  the 
line  of  treatment  recommended.     (N.  R.,  1,  8,  99.) 

Curettage : — When  other  means  have  failed,  and 
the  cervix  remains  thickened  and  enlarged,  the  entire 
surface  from  the  internal  to  the  external  os  should  be 
scraped  with  the  curette.  (K.  C.)  For  details  of 
procedure  see  works  on  Gynaecology. 

Schrceder's  Operation  : — This  is  indicated  when  the 
disease  has  penetrated  deeply,  where  superficial  ap- 
plications will  always  fail.  Deep  acting  caustics  may 
have  curative  effect,  but  they  produce  cicatrical  con- 
traction. Thorough  excision  and  covering  the  ex- 
posed surface  b3^  a  plastic  operation,  as  recommended 
by  Schroeder,  will  give  the  best  results.     (Dud.) 

Steam  Vaporization  for  the  treatment  of  endocer- 
vicitis  has  recently  been  employed.  See  Endometritis. 


ENDOMETRITIS  AND    METRITIS. 

ACUTE  ENDOMETRITIS  AND  METRITIS. 
Mild  Forms. 

Rest  in  bed  and  Hot  Vaginal  Douches,  tempera- 
ture, 115° ;  four  quarts  of  water  should  be  used  every 
three  or  four  hours.     (K.  C.) 


262  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Hot  Fomentations  :— Applied  over  the  hypogas- 
tritim  will  generally  control  pain  and  render  opi- 
ates unnecessary.     (Cp.) 

Scarification  of  the  Cervix : — May  be  employed 
with  good  effect  to  induce  rapid  depletion ;  after  an 
interval  of  four  or  five  hours,  use  hot  douches  fol- 
low^ed  by  glycerine  tampons.     (K.  C.) 

More  Severe  Forms. 

Gonorrhoeal : — Dilate  the  cervix  under  anaesthesia 
so  as  to  admit  a  small  sized  uterine  speculum,  then 
copiously  irrigate  with  Bichloride  of  Mercury,  1- 
3000,  use  a  quart,  then  pack  the  cavity  with  steril- 
ized gauze,  one  end  of  which  should  be  allowed  to 
remain  in  the  vagina  to  permit  of  easy  removal. 
The  vaginitis,  which  is  present,  should  receive  treat- 
ment. At  the  end  of  twenty-four  hours  this  pro- 
cedure should  be  repeated.  The  os  w^ill  remain  open 
sufficiently  to  dispense  w^ith  dilatation  again.  Creo- 
lin  will  facilitate  the  introduction  of  the  gauze. 
(K.C.) 

Argentamine  : — Has  been  used  w^ith  success  in  gon- 
orrhoeal forms.  A  hollow  rubber  sound  is  introduced 
into  the  uterus,  then  the  solution  is  poured  into  the 
speculum  and  reaches  the  cavity  of  the  uterus 
through  the  sound.  After  withdrawing  the  sound 
the  vagina  should  be  washed  out  carefully.  Solu- 
tions of  1-3000-2000,  and  later  1-1000  are  used. 
(N.  M.) 

Ice  or  the  Wet  Pack  to  the  Abdomen: — Should  be 
employed  in  conjunction  with  complete  rest.  (T., 
96.) 

Cauterization: — May  be  tried,  if  the  appendages 


ENDOMETRITIS   AND   METRITIS.  263 

are  in  good  condition,  in  order  to  destroy  the  gono- 
cocci,  use  Phenol  Alcohol,  50  per  cent.  Chloride  of 
Zinc,  20  per  cent.,  Tr.  Iodine,  20  per  cent.,  or  Ni- 
trate of  Silver,  10  per  cent.     (T.,  96.) 

Septic  Inflammation  Folio  wing  Operations : — When 
in  the  non-pregnant  uterus  prompt  measures  are  nec- 
essary^ ;  the  cut  surfaces  of  the  cervix  should  be  ex- 
posed and  freely  cauterized  v^'ith  pure  Carbolic  Acid, 
and  the  uterine  cavity  irrigated  with  Bichloride  of 
Mercury  Solution,  1-3000,  then  packed  with  Steril- 
ized Gauze.  Curetting  is  rarely  required  in  this  con- 
dition. The  wounded  surfaces  should  be  kept  apart 
by  sterilized  gauze  v^^hich  should  be  retained  by  pack- 
ing the  vagina  with  the  same.  If  the  symptoms  im- 
prove, remove  the  vaginal  packing  at  the  end  of  tw^o 
days,  leaving  that  of  the  uterus  in  place  for  four  or 
five  days.  It  should  then  be  withdraw^n  and  the 
cavity  not  entered  again.  Vaginal  douches  should 
be  employed  after  the  removal  of  the  vaginal  pack- 
ing and  continued  until  the  removal  of  the  uterine 
packing;  then  apply  glycerine  tampons.  The  cut 
surfaces  should  then  receive  attention,  being  treated 
by  cauterants  and  astringents,  or  a  new  operation 
performed  as  deemed  best.  If  unfavorable  symp- 
toms continue,  employ  the  treatment  mentioned  for 
the  graver  forms.     (K.  C.) 

Grave  Forms  of  Inflammation — Puerperal. 
See  also  Septicemia. 

Curettage : — The  cavity  of  the  uterus  should  receive 
prompt  and  energetic  treatment  without  delay. 

Cleanse  the  vulva,  vagina,  cervix,  and  cervical 
canal  with  a  copious  supply  of  water  and  green  soap, 


264  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

using  the  finger  and  a  wad  of  cotton  in  a  pair  of  long 
handled  forceps.  Dilate  the  internal  os  if  necessary ; 
then  irrigate  the  cavity  of  the  uterus  freely  with  bi- 
chloride of  mercurj',  1—2000.  After  the  irrigation 
curettage  should  be  done,  examining  \vith  the  fingers 
from  time  to  time  to  make  sure  that  all  detritus  has 
been  removed.  The  sharp  curette,  double  curette  for- 
ceps, or  placental  forceps  are  recommended.  After 
curetting,  irrigate  w4th  the  same  solution  at  a  tem- 
perature of  115°  to  120°.  Even  if  there  is  excessive 
haemorrhage,  little  time  should  be  given  during  curet- 
ting to  checking  the  bleeding,  which  is  most  always 
copious,  as  the  hot  irrigation  soon  to  be  applied 
will  arrest  it.  After  this  procedure  pack  the  uterine 
cavity  with  folds  of  sterilized  gauze  through  the 
uterine  speculum.  At  the  end  of  twenty-four  hours 
remove  the  packing,  and  if  there  is  no  fever  the 
cavity  of  the  uterus  may  be  left,  but  if  the  tempera- 
ture is  still  elevated  remove  the  packing,  irrigate  and 
apply  fresh.  This  should  be  repeated  at  intervals  as 
indicated.  This  treatment  by  curettage  and  drain- 
age should  be  persistently  pursued  in  even  the  most 
desperate  cases.     (K.  C.) 

Alcohol  Gauze : — Gauze  soaked  in  alcohol  and  used 
for  packing  is  recommended  by  Grandin,  who  says 
iodoform  gauze  is  liable  occasionally  to  produce  poi- 
soning.    (E.J.) 

Hydrogen  Peroxide: — Commended  for  flushing  out 
cavity  of  uterus  after  curettage.     (Al.) 

Lysol,  Potass.  Permang.,  and  Carbolic  Acid,  in 
vaginal  douches  may  be  repeated  every  tw^o  or  three 
hours;  if  there  is  no  improvement  wash  out  the 
uterus  w^ith  mild  antiseptic  solutions,  repeating 
every  twelve  or  twenty-four  hours.     (T.,  96.) 


ENDOMETRITIS   AND   METRITIS.  265 

Camphorated  Alcohol : — Recommended  for  cauter- 
izing after  curettage  for  removal  of  placental  frag- 
ments.    (T.,  96.) 

Continuous  Irrigation  : — Advocated  when  the  tem- 
perature remains  unaffected.  Weak  Carbolic,  Boric 
Acid,  or  Lysol  solutions  are  used.  Irrigation  is 
maintained  continuously  for  twelve  hours  or  more. 
Following  this  the  inner  surface  of  the  uterus  is 
painted  with  Tincture  of  Iodine  undiluted.    (T.,  98.) 

Antistreptococci  Serum : — The  class  of  cases  in 
which  the  serum  is  of  value  includes  those  which 
arise  from  the  presence  of  the  streptococcus  pyogenes 
the  common  tj^pe  of  septicaemia.  Puerperal  infection 
caused  by  the  gonococcus,  the  bacillus  coli  com- 
munis and  the  staphylococcus  are  not  "amenable  to 
the  antistreptococci  serum.  For  the  method  of  ad- 
ministration of  this  agent  see  Septicaemia.     (T.,  99.) 

CHRONIC  ENDOMETRITIS  AND  METRITIS. 

Displacements  and  lacerations  should  receive  im- 
mediate attention. 

Acute  and  subacute  metritis,  inflammation  of  the 
appendages,  para-  and  perimetritis,  are  contra-indi- 
cations  to  local  interference  in  the  endometrium. 
Cervical  or  vaginal  catarrh  if  present  should  also  re- 
ceive attention. 

The  plug  of  mucus  in  the  cervical  canal  must  first 
be  extracted  before  anything  can  be  accomplished; 
this  is  sometimes  difficult  with  ordinary  forceps  or 
applications  of  cotton.  In  this  case  a  small  syringe 
with  a  short  rubber  tubing  attached  to  the  nozzle 
may  be  used.  The  tubing  is  inserted  into  the  ex- 
ternal OS,   and   the  mucus  removed  by  suction.     A 


266         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

narrow  piece  of  sponge  on  forceps  may  also  be  em- 
ploj'-ed  for  this  purpose.  If  the  os  is  contracted  it 
must  be  dilated  or  incised  in  order  to  admit  of  free 
exit  for  the  pent  up  secretions.     (Sw.) 

The  remedies  mentioned  for  chronic  endocervicitis 
for  application  to  the  external  os  and  cervical  canal 
are  also  indicated  in  this  condition.  The  reader  is, 
therefore,  referred  to  that  subject. 

Local  Depletion : — Will  temporarily  relieve,  allow- 
ing about  half  an  ounce  of  blood  to  escape  by  punct- 
ure or  scarification.     (Sw.) 

Hot  Water  Douches  and  Hot  Sitz  Baths :— The 
systematic  use  of  the  hot  douche  combined  w^ith  the 
hot  sitz  bath  is  very  important.     (Sw^) 

Glycerine  Tampons: — Frequently  applied  tend  to 
depletion,  and  should  follow  daily  the  hot  water 
douches.     (K.  C.) 

Electricity: — Great  benefit  is  sometimes  afforded 
by  a  mild  galvanic  current  applied  every  second  or 
third  day,  negative  pole  in  the  uterus,  positive  over 
the  hypogastrium.  The  current  should  be  from  8  to 
12  milliamperes.  (Sw.)  In  the  stage  of  infiltration 
the  positive  pole  of  the  galvanic  current  and  zinc  elec- 
trolysis with  faradization;  in  the  stage  of  indura- 
tion, dilatation,  curettage  and  gauze  packing  prove 
more  satisfactory  according  to  Goelet.     (Sj.) 

Intrauterine  Applications:  —  In  addition  to  the 
aforementioned  remedial  agents,  applications  di- 
rectly to  the  surface  of  the  endometrium  are  em- 
ployed. There  seems  to  be  some  divergence  of  opin- 
ion as  to  the  utility  of  these  measures,  especially  in 
regard  to  the  cauterants,  which  are  condemned  by 
some  as  more  harmful  than  productive  of  good.  On 
the  other  hand,  the  most  recent  writers  advocate 


ENDOMETRITIS  AND  METRITIS.  267 

their  employment.  The  remedies  which  meet  with 
the  most  general  approbation  in  utraiiterine  treat- 
ment are  Iodized  Phenol,  Carbolic  Acid  pure,  and 
Iodine ;  the  best  results  being  obtained  after  curet- 
tage. Before  adopting  this  method  the  os  should  be 
dilated  with  laminaria  tents,  and  no  irrigation  of  the 
uterine  cavity  should  be  attempted  unless  the  os  is 
patulous.  The  external  parts  should  be  scrubbed 
with  soap  and  w^ater,  antiseptic  vaginal  douches  ad- 
ministered, the  vagina  wiped  dry  and  swabbed  with 
a  5  per  cent,  solution  of  Carbolic  Acid,  then  with  a 
1  per  cent,  solution  of  Creolin ;  slight  traction  is 
made  on  the  cervix  with  the  blunt  hook  or  tenacu- 
lum. After  the  application  has  been  made,  a  tampon 
of  Ichthyol  Ammoniate  1-10  in  glycerine  is  advised, 
and  over  this  a  dry  cotton  tampon.     (Dud.) 

Carbolic  Acid : — The  undiluted  acid  is  generally  re- 
garded as  the  safest  and  most  efficient  remedy,  since 
it  does  not  burn  deep  enough  to  destroy  the  submu- 
cous tissue.  (Sj.)  According  to  Bartholovi'  it  is  the 
best  agent  for  the  treatment  of  uterine  catarrh. 

Ichthyol: — Applied  pure  to  the  fundus  gives  relief 
to  pain  and  dragging  sensation  and  lessens  leucor- 
rhoea.     (F.) 

Tr.  lodi  Comp.  (Churchill's): — This  remedy  is 
much  used  and  is  very  generally  advised.     (Sw.) 

Iron  Sesqui chloride: — In  mild  forms  with  metror- 
rhagia, also  in  bleeding  from  myomata,  and  paren- 
chymatous haemorrhages,  injections  into  the  uterine 
cavity  without  dilatation  have  been  recommended. 
(T.,96.) 

Zinc  Chloride: — 10  per  cent,  solutions  are  used. 
Munde  has  employed  50  per  cent,  solutions  with 
good  results  in  the  worst  cases.    The  solution  is  to 


268  DIGEST   OF  EXTERNAL  THERAPEUTICS. 

be  thoroughly  applied  and  followed  by  the  insertion 
of  a  sterilized  drain  through  the  internal  os.  Treat- 
ment by  this  agent  has  been  abandoned  by  many 
because  of  the  tendency  to  cicatrization  of  the  sur- 
face.     (Sj.) 

Iodized  Phenol: — Recommended  also  byMunde  for 
use  in  milder  cases,  and  for  cauterization  after  the 
use  of  the  strong  zinc  chloride,  when  a  second  cauter- 
ant  application  is  deemed  advisable.  A  sterilized 
drainage  tube  is  to  be  inserted  through  the  internal 
OS  as  above. 

Nitric  Acid : — When  the  disease  fails  to  respond  to 
ordinary  treatment,  and  the  mucous  follicles  are  the 
seat  of  cystic  degeneration,  or  when  the  granula- 
tions have  become  very  exuberant,  this  agent  is  use- 
ful. The  cavity  of  the  uterus  may  be  touched  with  a 
cotton  wrapped  applicator  dipped  in  the  acid;  the 
parts  should  be  first  thoroughly  cleansed  and  the 
cervix  w^ell  protected  from  the  acid.  It  is  well  to 
place  in  the  vagina  beneath  the  cervix  a  pledget  of 
cotton  soaked  in  a  solution  of  bicarbonate  of  soda 
to  protect  the  vaginal  mucous  membrane.  After  the 
acid  has  been  used,  remove  the  cotton  and  syringe 
with  water,  after  which  a  glycerine  tampon  is  ap- 
plied and  renewed  daily.  Nitric  acid  is  condemned 
by  some  writers,  together  with  other  powerful  caus- 
tics, as  decidedly  injurious.  It  is,  however,  recom- 
mended in  those  cases  of  the  haemorrhagic  type 
which  develop  in  connection  with  the  menopause 
and  membraneous  exudation.  A  vulcanite  intra- 
uterine speculum  is  recommended  to  prevent  the  acid 
from  getting  on  the  cervical  canal.     (Alb.) 

Actual  Cautery: — This  agent  may  be  employed  in 
inveterate  cases  of  the  variety  mentioned  as  indicat- 
ing the  use  of  nitric  acid.     (K.  C.) 


ENDOMETRITIS  AND  METRITIS.  269 

Chromic  Acid: — Solution  of  15  grains  to  1  drachm. 
(B.) 

Curettage:  —  For  intractable  forms,  contra-indi- 
cated when  there  is  inflammation  of  the  uterine  ap- 
pendages; anaesthesia  and  thorough  antisepsis  are 
essential.  After  thoroughly  cleansing  and  douching 
with  antiseptic  solutions,  dilate  the  cervix,  insert  a 
uterine  cylindrical  speculum,  and  flush  the  cavity  of 
the  uterus  with  a  warm  solution  of  bichloride  of  mer- 
cury, 1-2000,  to  the  amount  of  one  or  two  pints. 
Then  follow  v^rith  the  curette,  using  a  sharp  instru- 
ment aided  by  the  double  curette  or  forceps  of 
Emmet.  After  this  introduce  again  the  uterine  spec- 
ulum and  irrigate  copiously  with  the  bichloride  solu- 
tion same  as  before.  The  uterus  is  then  packed  with 
a  strip  of  gauze  which  has  been  previously  placed  in 
a  bichloride  of  mercury  solution  1—500.  This  gauze 
should  be  a  strip  about  four  feet  in  length  and  folded 
four  times.  Catch  an  end  upon  a  Sims  tampon 
screw,  and  pass  it  into  the  uterus  through  the  specu- 
lum, length  by  length,  packing  it  in  carefully,  first  at 
one  cornu  then  at  the  other,  then  at  the  fundus, 
gradually  withdrawing  the  speculum.  The  vagina  is 
then  packed  with  gauze.  At  the  end  of  forty-eight 
hours  the  vaginal  packing  is  removed ;  the  vagina  is 
then  douched  twice  daily  until  the  uterine  pa.cking  is 
removed,  v^hich  is  done  on  the  sixth  day.  The  vigor 
with  which  the  curettage  is  performed  will  depend 
upon  the  conditions  present;  haemorrhagic  forms  call 
for  a  more  energetic  application  than  recent  subin- 
volution, or  the  endometritis  of  simple  stenosis.  The 
anterior  and  posterior  walls,  the  fundus  and  the  sulci 
and  the  recesses  of  each  cornu  are  all  to  be  scraped  in 
turn.     (K.  C.)     (Alb.) 


270         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

The  following  line  of  treatment  has  been  suggested 
for  endometritis  in  aged  women  attended  with  puru- 
lent vaginal  discharge:  Swab  out  the  vagina  with 
strong  Carbolic  Acid,  or  prescribe  frequent  astring- 
ent injections  such  as  Zinc  Chloride  5  to  10  grains  to 
the  pint.  Repeat  the  carbolic  acid  applications  two 
or  three  times,  taking  care  that  none  goes  on  the 
vulva.  If  this  is  not  successful,  dilate  the  cervix 
with  laminaria  tents  and  explore  the  interior;  if 
growths  are  discovered  examine  specimens  of  the 
structure  microscopically ;  if  there  are  no  growths 
scrape  with  the  blunt  curette  and  SAvab  the  cavity 
writh  Carbolic  Acid.  This  is  said  to  always  remove 
the  symptoms  for  a  time.     (T.,  98.) 

The  following  are  recommended  for  glandular 
forms : 

Sodium  Solutions: — To  remove  mucous  secretions, 
employ  sodium  solutions  injected  daily  by  means  of 
a  simple  catheter,  followed  by  Carbolic  Acid  2^2  per 
cent,  solution,  and  finally  by  Lysol  Solution  1  per 
cent.  Another  plan  of  treatment  for  slight  glandular 
endometritis  consists  of  the  injection  of  V^  to  1/2 
quart  of  Sodium  Solution,  3  per  cent.,  followed  by 
(according  to  caue)  Carbolic  Acid,  2  per  cent.,  Lysol, 
V2  per  cent.,  Nitrate  of  Silver,  2  per  cent.,  or  Zinc 
Chloride  or  Cupric  Sulphate  or  Cupric  Aluminate,  5 
per  cent.  These  injections  are  made  into  the  uterus 
through  an  ordinary  catheter,  the  instrument  being 
moved  from  side  to  side  to  allow  the  fluid  to  flow  out. 

The  instrument  having  been  removed,  a  tampon  of 
iodoform  gauze  is  placed  below  the  uterus,  and  the 
patient  allowed  to  rest  an  hour  to  avert  uterine 
colic.     (T.,  96.) 

Traumatol: — Pencils  are  recommended  as  having 
produced  successful  results.     (F.) 


ENDOMETRITIS   AND   METRITIS.  271 

Vaporization: — Introduction  of  steam  into  the 
uterine  cavity  has  been  used  in  hyperplastic  endome- 
tritis wnth  severe  haemorrhage.  (F.)  With  regard 
to  the  technique  of  the  procedure,  the  use  of  a 
wooden  tube  for  the  protection  of  the  cervix  is  ad- 
vised. This  is  considered  preferable  to  gauze,  w^hich 
becomes  too  readih'  saturated  with  hot  vapor.  The 
wooden  tubes  should  be  kept  in  a  disinfectant  solu- 
tion. If  there  is  a  tendency  of  the  tubing  for  con- 
ducting the  steam  to  become  stopped  with  clots,  it 
will  be  necessary  to  carefully  empty  the  uterus  of 
blood ;  the  vapor  heated  to  110°  C.  will  arrest  the 
haemorrhage  in  a  short  time.  It  is  desirable  to  use 
vapor  for  the  shortest  possible  time;  one-quarter 
minute  is  sufficient  for  most  cases,  and  one-half  min- 
ute should  be  considered  the  maximum.  The  tem- 
perature should  range  between  102°  and  110°  C. 
The  higher  the  temperature  the  shorter  the  time  of 
application.     (C.  G.,  8,  24,  98.) 

Brothers,  in  writing  of  intrauterine  vaporization, 
says  that  although  the  treatment  of  haemorrhage  by 
heat  is  of  ancient  origin,  the  use  of  steam,  at  a 
temperature  of  the  boiling-point  or  above,  for  haemo- 
static purposes,  is  of  recent  origin.  After  describing 
the  apparatus  of  Pincus,  and  citing  twenty-one  cases 
in  his  ow^n  experience,  he  summarizes  the  present 
uses  of  vaporization  or  vapocauterization,  as  fol- 
lows: (1)  As  a  haemostatic  it  has  been  employed 
most  successfully  in  cases  of  non-malignant  post- 
climacteric uterine  hsemorrhages.  It  has  proved 
curative  in  the  various  irregular  bleedings  met  with 
in  connection  with  catarrhal  fungoid,  or  haemor- 
rhagic  endometritis.  It  acts  as  a  palliative  measure 
in  certain  cases  of  fibroid  tumor  or  inoperable  car- 


272  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

cinoma  associated  with  haemorrhages;  (2)  as  a 
caustic  it  can  be  rehed  on  to  destroy  the  mucous  lin- 
ing of  the  uterus,  even  to  the  extent  of  obliterating 
the  uterine  canal ;  (3)  as  a  bactericide  it  may  be  used 
in  cases  of  gonorrhoeal  or  septic  puerperal  endome- 
tritis. Fenomenow  has  repeatedh'  had  the  uterus 
(which  w^as  subjected  to  vaporization  and  later  re- 
moved by  hysterectomy)  examined  bacteriologically 
and  proved  it  to  be  sterile;  (4)  to  reduce  the  bulk  of 
the  subinvoluted  uterus,  Pincus  has  frequently  re- 
sorted to  intraiiterine  vaporization  with  success; 
(5)  in  chronic  suppurating  fistulous  tracts,  Feno- 
menow has  reported  successful  results  in  cases  of  ab- 
dominal fistulas  of  several  years'  duration,  which 
had  resisted  all  other  methods  of  treatment.  (N.  Y. 
M.J.  5,  13,  99.) 

The  following  general  line  of  treatment  is  recom- 
mended in  place  of  more  conventional  methods  :  Va- 
ginal douches,  astringent  injections,  vaginal  and 
intraiiterine  applications  of  dry  powders,  intra- 
uterine pencils,  intrauterine  gauze  tamponing. 
(Dud.) 

Euphorbin: — Intrauterine  pencils  are  used.     (F.) 

The  following  solutions  are  recommended  by  Pozzi 
for  injections : 

Hydrarg.  Bichlorid.,  1-3000. 

Alum,  3SS-0J. 

Tannic  Acid,  ^ss-Oj. 

Boric  Acid,  Bj— Oj. 


ENURESIS.  273 


ENURESIS. 

The  bladder  should  be  emptied  before  retiring,  and 
the  patient  should  sleep  on  a  hard  mattress  ^^vith 
light  clothing,  and  avoid  lying  on  the  back ;  this  may 
be  prevented  b3''  fastening  an  empty  cotton  spool  to 
a  belt  so  arranged  as  to  cause  pressure  on  the  lum- 
bar region  as  soon  as  the  supine  position  is  assumed. 
About  two  hours  after  sleep  the  patient  should  be 
awakened,  as  it  is  at  this  time  usualh'  the  discharge 
of  urine  occurs. 

At  bedtime,  a  Warm  Bath  at  90°  to  98°  F.,  or  a 
Warm  Sitz  Bath  or  Cold  Sponging  of  the  lumbar 
region  is  often  of  value.  Open  air  Exercise  and  Cold 
Baths  every  morning  should  be  enjoined. 

Children  troubled  -with  urinary  incontinence  should 
be  taught  to  retain  their  water  during  the  day  as 
long  as  possible.     (Rd.) 

General  Massage,  Sponging  with  alcohol  and 
water  1—6,  Friction  with  coarse  towels,  and  Sea 
Bathing  are  beneficial. 

Nux  Vomica : — An  ointment  of  1  part  of  the  ex- 
tract with  16  of  lard.  A  portion  the  size  of  a  coffee 
bean  inserted  into  the  rectum  at  night  often  acts 
well.     (Jac.) 

Electricity: — The  interrupted  current,  one  electrode 
to  the  perineum,  the  other  to  the  epigastrium  or 
lumbar  region.     (Erb.) 

Collodion: — Applied  over  the  meatus,  sealing  it,  has 
been  used,  though  it  is  scarcely  to  be  recommended. 

Strychnine  : — Occasionally  subcutaneous  injections 
into  the  perineum  of  ^^  to  -^  grain  have  been  effect- 
ive in  intractable  and  desperate  cases.     (Jac.) 
19 


274    DIGEST  OF  EXTERNAL  THERAPEUTICS. 


EPIDIDYMITIS. 

Rest  and  suspension  of  the  scrotum  is  the  first  es- 
sential. When  the  onset  of  the  disease  is  announced 
by  pain  in  the  perineum,  dragging  sensation  in  the 
inguinal  region  and  frequent  urination,  a  Hot  Bath 
should  be  administered  and  the  patient  put  to  bed 
with  the  testicles  properlj^  supported.     (Cn.) 

Aspiration  or  Puncture  of  the  Tunica  Vaginalis: — 
This  is  indicated  when  the  pain  is  intense ;  in  severe 
forms  of  inflammation  it  affords  immediate  relief. 
The  sac  will  fill  up  again,  requiring  a  repetition  of 
the  operation,  to  which  the  patient  will  readily  as- 
sent, so  great  is  the  comfort  afforded  by  this  meas- 
ure. Antiseptic  precautions  are  enjoined.  After  the 
puncture,  and  also  when  it  has  not  been  performed, 
the  scrotum  should  be  wrapped  in  cotton,  covered 
w^ith  oiled  silk,  and  placed  in  a  shallow^  suspensory 
bandage  with  lacers,  so  that  equal  pressure  may  be 
maintained.     (CI.) 

Tobacco  and  Flaxseed  Poultice :  — Applied  every 
three  hours,  completely  enveloping  the  scrotum,  and 
covered  v^ith  oiled  silk  and  flannel,  is  useful.     (CI.) 

Hamamelis: — The  tincture  applied  hot  in  the  same 
manner  as  the  poultice  affords  great  relief.     (CI.) 

Cold : — The  usual  Ice  bag  or  bladder  w^ill  act  satis. 
factorily  for  the  relief  of  pain  and  inflammation. 
Ethyl  Chloride  also  relieves  and  reduces  inflamma- 
tion.    (F.) 

Mercurial  Ointment: — Alone  or  mixed  with  equal 
parts  of  Extract  of  Belladonna  made  into  a  paste, 


EPILEPSY.  275 

after  the  acute  and  painful  symptoms  have  subsided, 
for  the  reduction  of  sweUing.     (CI.) 

Ammonium  Chloride: — 4  drachms  to  the  pint,  for 
reduction  of  swelling  in  the  latter  stages.     (Al.) 

Nitrate  of  Silver: — 10  grains  to  the  ounce  in  the 
form  of  an  ointment  is  sometimes  used.     (CI.) 

Strapping  : — When  the  pain  has  ceased  this  is  indi- 
cated for  the  reduction  of  swelling ;  pain  sometimes 
follows  its  application,  but  it  usually  disappears  in 
an  hour  or  tw^o ;  if  it  continues  the  straps  should  be 
removed,  for  in  this  case  they  are  too  tight.  The  fol- 
lowing is  the  method  of  application:  First  remove 
the  hair  from  the  scrotum  and  render  the  parts 
aseptic,  then  cut  strips  of  adhesive  plaster  an  inch 
wide  and  6  to  8  inches  long.  The  spermatic  cord 
about  the  swelling  is  encircled  with  the  left  hand, 
and  the  tumor  pressed  well  dow^n  into  the  scrotum, 
rendering  the  walls  tense  and  firm.  A  piece  of  muslin 
bandage  is  now  carried  tw^ice  around  the  part  in- 
volved at  the  upper  border  and  fastened  at  the  end 
by  a  strip  of  adhesive  plaster.  The  muslin  prevents 
the  adhesive  straps  from  cutting.  The  straps  are 
now  applied,  encircling  the  upper  part  of  the 
scrotum,  overlapping  one  another  from  above  down- 
ward, until  a  little  below  the  centre,  when  the  direc- 
tion is  changed  and  carried  under  the  scrotum,  bring- 
ing the  pendulous  parts  upward.  A  single  strap  to 
hold  the  ends  will  complete  the  dressing.  After 
which  a  suspensory  bandage  should  be  put  on  and 
the  patient  permitted  to  go  about.     (CI.) 


EPILEPSY. 

See  Convulsions. 


276    DIGEST  OF  EXTERNAL  THERAPEUTICS. 


EPISTAXIS. 

Ice  should  be  applied  to  the  forehead  and  back  of 
the  neck,  and  a  small  piece  inserted  up  the  nostril; 
raise  the  arms  above  the  head  and  hold  them  there 
for  a  short  time;  press  horizontally  on  the  face 
bones  with  the  fingers  just  above  the  nostrils,  and 
so  compress  the  blood  supply.  Immerse  the  feet  and 
legs  in  hot  water-  (Bt.)  The  patient  should  sit  up- 
right, and  grasp  the  nostrils  tightly  between  the 
thumb  and  index  finger,  so  as  to  prevent  the  passage 
of  air.  Compress  the  facial  artery  and  resort  at 
once  to  tampons  if  haemorrhage  becomes  dangerous. 
(Whar.) 

Tannic  Acid  or  Alum : — In  powder  by  insufflation 
or  solution  by  atomizer  are  both  very  usefiil.     (Bos.) 

Agaricus  Chirurgorum  :  — Used  for  plugging  the 
nostrils.     (F.) 

Antipyrin : — 20  to  50  per  cent,  as  spra}^  or  the 
powder  by  insufflation.     (Bn.) 

Hot  W^ater : — Of  service  when  atrophic  rhinitis 
exists.     (Al.) 

Nitrate  of  Silver: — When  a  small  abrasion  or  ulcer 
is  the  cause,  which  is  accessible,  touch  the  part  with 
a  strong  solution.     (Al.) 

Hydrogen  Peroxide  : — Injections  into  nostril  full 
strength,  it  is  said  to  be  very  effective ;  or  a  plug  of 
cotton  saturated  with  the  remedj^  ma\'  be  inserted 
into  the  nostril.     (T.,  98.) 

Iodoform  Gauze  dipped  in  Glycerite  of  Tannin  and 
used  as  a  tampon  is  effective.      (T.,  96.) 


EPISTAXIS.  277 

Cocaine : — One  of  the  most  reliable  remedies.  It 
may  be  applied  on  pledgets  of  cotton  carried  well  into 
the  nasal  cavity,  or  better  in  the  following  applied 
with  the  atomizer : 


M 


9;.    Cocain.  Hydrochloratis, 

gr.  XX, 

Aq.  Destill., 

3ss. 

:.  Ft.  sol.  et  adde 

Liq.  Petrolati  vel  Ol.  Olivae, 

adgj- 

M. 

(Bos.) 

Zinc  Sulphate: — The  pow^der  or  stronger  solution 
of  about  40  per  cent.     (F.) 

The  following  are  also  recommended  for  applica- 
tion in  the  form  of  sprays,  or  on  little  mops  of  cot- 
ton, or  in  more  severe  cases  on  tampons : 

Tr.  Hamamelis ;  Tr.  Perchloride  of  Iron ;  Liq. 
Ferri  Sulph.,  1  part,  water,  8  parts;  Vinegar  or 
Acetic  Acid,  1  part  to  5  parts  water  (Rd.)  (B.)  (Al.) 

Tamponing  : — The  anterior  and  posterior  nares 
may  be  tamponed  at  the  same  time,  after  the  usual 
method  described  in  all  surgical  works,  is  necessary 
in  severe  cases.  A  soft  rubber  catheter,  however,  is 
preferable  to  Bellocq's. 

Plugging  with  Small  Sponges  : — This  may  be  done 
in  the  following  manner :  Introduce  into  the  interior 
nares  a  small  piece  of  sponge  tied  to  a  short  silk  lig- 
ature, push  it  back  along  the  floor  of  the  nose  to  the 
posterior  nares ;  a  small  piece  of  sponge  about  the 
size  of  a  marble,  with  a  hole  in  the  centre  of  it  is  then 
threaded  on  the  ligature  through  the  hole,  this  is 
pushed  backward  until  it  comes  in  contact  with  the 
first  piece;  then  another  is  introduced  in  the  same 
way,  and  so  on  until  the  cavity  is  completely  filled 
up    and    the    haemorrhage    arrested.     The   sponges 


278  DIGEST   OF    EXTERNAL  THERAPEUTICS. 

should  be  rendered  thoroughly  aseptic,  and  should 
also  be  washed  in  some  antiseptic  solution.  They 
maj^  remain  in  from  twenty-four  to  forty-eight 
hours.     (Whar.) 

Cauterants: — The  galvano-cauterA'  or  chromic  acid 
crystals  on  a  silver  probe  may  be  used  when  the  pa- 
tient is  not  bleeding,  but  has  recently  done  so.  By 
throwing  a  strong  light  up  the  nostrils  the  affected 
parts  may  be  seen  and  touched.  The  galvano- 
cautery  is  condemned  by  some  observers,  who  claim 
that  when  the  bleeding  points  can  be  located  a 
crayon  of  nitrate  of  silver  or  a  crystal  of  chromic 
acid  will  usually  answer  the  purpose,  and  if  these 
fail  an  ordinary  silver  probe  heated  to  a  dull  heat 
over  a  spirit  lamp  will  take  the  place  of  the  galvano- 
cautery,  at  the  same  time  being  very  much  more 
available  and  more  easily  applied. 


EPITHELIOMA. 

Extirpation  by  the  knife  is  favored  by  most  sur- 
geons, who  advocate  its  performance  in  all  cases 
w^hen  practicable  except  those  of  the  most  superficial 
nature,  early  removal  being  regarded  as  a  matter  of 
urgent  necessity'.  Dermatologists,  on  the  other  hand, 
incline  decidedly  to  the  use  of  caustics,  reserving  op- 
erative measures  entirely  for  those  parts  where  it  is 
possible  to  remove  a  large  amount  of  tissue  w^ithout 
injury  to  the  patient.  Caustics  they  also  regard  as 
more  certain  of  success  and  productive  of  less  de- 
formity. 

From  the  surgeon's  standpoint  there  are  two 
classes  of  cases  in  w^hich  non-operative  treatment  is 


EPITHELIOMA.  279 

of  service ;  those  in  which  the  lesion,  as  first  men- 
tioned, is  of  a  most  superficial  character,  and  where 
such  treatment  is  often  successful,  and  those  in 
which  operative  measures  are  absolutely  refused,  or 
where  from  the  nature  of  the  case  they  are  not 
deemed  advisable. 

Non-operative  treatment  should  aim  at  the  com- 
plete destruction  of  the  diseased  tissues  and  no  super- 
ficial caustics  should  ever  be  used,  for  they  do  more 
harm  than  good. 

The  following  are  some  of  the  most  important 
methods  suggested  for  the  local  treatment  of  this 
disease : 

Arsenious  Acid : — This  agent  holds  the  first  place 
among  escharotics  and  forms  the  basis  of  several 
w^ell-known  pastes. 

Arsenical  pastes  should  have  the  consistency  of 
firm  butter;  the  strength  and  duration  of  applica- 
tions will  vary  according  to  the  character  of  the 
cancer.  Hardav^ay  says  he  regulates  the  strength 
according  to  the  case,  never  making  it  w^eaker  than 
equal  parts, or  stronger  than  Marsden's.  The  same 
writer  also  says  that  the  desired  action  must  be  ob- 
tained, otherwise  the  patient  is  injured.  Antiseptic 
dressings  are  not  necessary,  as  the  toxines  from  the 
pus  organisms  are  of  service  in  destroying  pathologi- 
cal epithelia.     (B.  H.) 

Marsden^s  Paste: — Composed  of  2  parts  of  arseni- 
ous acid  to  1  of  gum  acacia  rubbed  together  and 
made  into  a  paste  w^ith  w^ater,  w^hich  is  added  just 
before  applying.  It  is  exceedingly  painful  and  causes 
cedema.  It  must  be  left  on  for  twelve  to  twenty-four 
hours,  according  to  the  endurance  of  the  patient. 
The  application  must  be  repeated  if  the  growth  is 


280  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

not  destroyed.  Poultices  are  continually  applied 
after  the  removal  of  the  pasts  until  the  slough  sepa- 
rates.    (Kp.) 

Manec's  Paste: — This  has  stood  the  test  of  time. 
(See  Cancer,  under  arsenious  acid,  for  formula.)  Be- 
fore application,  the  diseased  part  must  be  thor- 
oughly cleansed  of  all  crusts  and  detritus  by  the  use 
of  poultices,  etc.  Then  the  paste  is  to  be  spread  on 
lint  and  closely  fitted  and  held  firmh'  in  place  by 
plasters.  The  applications  must  be  kept  up  for  one 
or  two  weeks,  at  the  end  of  Avhich  time  the  eschar 
falls  o£f. 

For  the  other  arsenical  preparations  of  this  nature 
see  Cancer. 

Caustic  Potassa  : — According  to  Van  Harlingen 
this  remedy  never  fails  to  remove  superficial  growths 
when  properly  applied.  A  stick  of  the  potassa  is 
wrapped  in  a  rag,  leaving  the  point  exposed.  This  is 
first  passed  over  the  surface  gently,  in  order  to  dis- 
solve the  homy  epithelia ;  afterwards  it  is  bored 
dow^n  into  every  part  of  the  growth.  When  apply- 
ing it  w^ill  be  seen  that  the  unhealthy  tissue  readily 
gives  aAvay.  The  action  of  the  caustic  being  always 
a  little  beyond  the  point  of  actual  contact,  this  fact 
must  be  taken  into  consideration  when  operating 
near  important  organs.  Severe  pain  will  be  caused 
which  may  be  neutralized  b3'  the  application  of  4  to 
8  per  cent,  solutions  of  cocaine.  Dilute  acetic  acid  or 
weak  vinegar  should  be  applied  with  cloths,  to  neu- 
tralize the  caustic  influence  when  it  has  gone  far 
enough  and  also  to  lessen  the  pain.  The  part  should 
be  dressed  with  olive  oil  or  some  soothing  ointment 
and  changed  daily.  At  the  end  of  a  week  or  ten  daj^s 
the  eschar  falls  off".     After  which  a  rapidly  granulat- 


EPITHELIOMA.  281 

ing  surface  appears,  Avhich  leaves  only  a  small  scar 
after  healing. 

Methylene  Blue: — Solutions  of  1-20,  hypodermic- 
ally,  when  the  growth  is  deep  seated.     (T.,  96.) 

Pyrogallic  Acid: — This  remedy  is  considered  by 
many  observers  as  the  best ;  it  has  the  advantage  of 
being  almost  painless ;  a  drachm  to  the  ounce  is  the 
usual  strength  of  its  application,  w^hich  should  be 
continued  consecutively  for  from  two  to  six  days.  It 
will  have  to  be  reapplied  from  time  to  time  and  the 
slough  scraped  away.     (F.) 

Citric  Acid: — A  lotion  for  the  relief  of  pain  is  made 
from  a  solution  of  5  to  6  grains  to  1  ounce  of  vv^ater. 
(Al.) 

Schwimmer's  Treatment: — This  is  adapted  to  su- 
perficial epithelioma,  and  to  some  forms  of  the  infil- 
trating variety.  The  growth  is  scraped  out  thor- 
oughly with  a  dermal  curette,  the  diseased  tissues 
readily  giving  way.  Haemorrhage  should  be  stopped 
by  pressure.  After  curetting  pyrogallic  acid  in  an 
ointment  (1  part  to  2  of  base)  is  applied  for  four  or 
six  days.  The  ointment  produces  a  black  crust  and 
free  discharge ;  at  the  end  of  the  four  to  six  days  this 
should  be  softened  by  applications  of  carbolized 
vaseline  left  on  for  a  daj'  or  two.  After  its  removal 
apply  mercurial  plaster,  under  which  the  part  w^ill 
heal.     (Ja.) 

Zinc  Chloride : — Though  rarely  indicated  is  some- 
times employed  in  solution,  paste,  or  stick.  It  de- 
stroys both  normal  and  diseased  tissue,  though  not 
in  equal  degree.  It  may  be  used  in  papillomatous 
growths  until  the  base  is  reached,  then  another 
caustic  should  be  used.    Solutions  of  this  agent  may 


282         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

be  injected  into  small  tumors,  where  arsenious  acid 
and  caustic  potassa  cannot  be  used. 

The  formula  known  as  Bongard's  Paste,  which  is 
usually  employed,  is  as  follows : 

9?.    Farinae  Tritici, 

Amyli,  aa  5j- 

Pulv.  Acid.  Arsenosi,  gr.  viij. 

Hydrarg.  Sulph.  Rub.,  ^ij. 

Ammon.   Chloridi,         .  ^ij. 

Hydrarg.  Bichlorid.,  gr.  iv. 

Zinc.  Chloridi  Cryst.,  5j. 

Aq.  Fervid.,  S^^s. 

M. 
The  first  six  substances  are  finely  ground  then  mixed  in  a  glass 
jar.  The  zinc  chloride  is  dissolved  in  boiling  water,  then  added 
to  the  contents  of  the  mortar,  which  should  be  stirred  until  all  the 
solution  is  incorporated.  Cocaine  (5  to  10  per  cent,  solution)  may 
be  added  before  applying. 

The  paste  is  spread  on  muslin  and  left  on  for  twenty-four  hours. 
If  the  application  is  successful  all  the  diseased  tissues  will  appear 
necrosed.  When  the  growths  are  large,  several  applications  are 
necessary.     (B.  H.) 

For  other  preparations  of  this  remedy  see  Cancer. 

Lactic  Acid: — A  powerful  caustic.  Equal  parts 
mixed  with  finely  powdered  silica  are  spread  on  gum 
paper  and  allowed  to  remain  on  from  twelve  to 
twenty-four  hours.  (Ja.)  The  concentrated  acid  has 
also  been  used  applied  on  cotton  cloths  and  covered 
with  an  impermeable  tissue  and  bandage.  The  sur- 
rounding skin  should  be  protected  with  adhesive 
plaster.  After  the  removal  of  the  caustic,  the  part 
should  be  cleansed  with  cold  water  and  dressed  with 
w^ater  dressings  for  from  twelve  to  twenty-four 
hours.     (N.) 

Nitric  Acid: — 10  parts  of  the  fuming  acid  with  4 
of  Bichloride  of  Mercury,  made  in  a  syrup  by  the 


ERYSIPELAS.  283 

addition  of  Bibulous  Paper,  is  said  to  form  a  good 
caustic  which  will  leave  excellent  cicatrices.  (T.,  96.) 
Chloracetic  Acid:  —  This  is  less  suitable  than 
stronger  escharotics,  but  will  be  of  service  when  the 
disease  is  close  to  some  important  organ,  as  the  eye, 
where  the  influence  of  the  caustic  must  be  circum- 
scribed. Its  action  not  being  deep,  applications 
must  be  repeated  at  intervals;  a  stick  or  a  probe 
covered  with  cotton  may  be  used.     (Al.) 


ERYSIPELAS. 

A  great  variety  of  local  remedies  have  been  advised 
for  this  affection,  many  of  which  are  not  only  unnec- 
essary, but  of  questionable  utility,  especially  in  the 
milder  types,  when  only  the  simplest  applications,  if 
any,  will  be  required. 

As  the  exclusion  of  air  from  the  surface  is  grateful, 
the  part  should  be  covered  with  a  light  dressing,  and 
when  the  face  is  the  seat  of  the  affection  a  light  linen 
or  muslin  mask,  saturated  with  the  selected  remedy, 
may  be  worn  with  benefit. 

Cold  W^ater  Dressings: — Suitable  for  mild  cases, 
forming  an  important  and  useful  adjuvant;  they 
should  be  changed  frequently.  (Gn.)  After  mention- 
ing a  number  of  applications,  Osier  adds  that  per- 
haps these  dressings  are  as  good  as  any. 

Carbolized  Olive  Oil : — 1  per  cent,  for  facial  erysip- 
elas.    (Den.) 

Ichthyol: — The  most  highly  praised  of  all  remedies. 
It  is  used  in  various  combinations.  Before  applying, 
the  affected  part  should  be  cleansed  w4th  soap  and 
water,  then  washed  with  a  solution  of  bichloride  of 


284  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

mercury;  the  ichthyol  preparation  should  then  be 
thickly  spread  on  and  covered  with  cotton  batting. 
(Al.) 

A  50  per  cent,  ointment  with  lanoline  is  recom- 
mended by  Unna,  covering  after  with  salicylated 
cotton.  It  is  claimed  that  it  arrests  the  progress  of 
the  disease.     (T.,  96.) 

With  Collodion,  Unna  has  found  the  following  pig- 
ment of  service : 

9;.    Ichthyoli, 

Etheris,  aa  ^ss. 

Collodii,  5J. 

M.  (Al.) 

With  Traumaticine,  it  is  said  to  have  aborted  60 
per  cent,  of  cases.  The  proportions  are  ichthyol  3 
parts,  traumaticine  10  parts;  this  combination, 
w^hich  makes  a  dark  brown  liquid,  should  be  applied 
to  the  diseased  area  with  a  brush,  and  at  least  three- 
quarters  of  an  inch  beyond.     (F.) 

The  remedy  is  said  to  be  indicated  in  all  varieties 
of  the  disease .     ( Sj . ) 

Lead  and  Opium  ^A^ash: — This  old  fashioned  rem- 
edy is  still  regarded  as  one  of  the  most  effective.  It 
is  useful  to  allay  the  burning.  Use  laudanum,  2 
parts,  and  liq.  plumbi  dilutus  (U.  S.  P. ),  4  parts.  (Ty.) 

Trichlorphenol: — 1  to  2  per  cent,  ointment  is  very 
effective.     ( F. ) 

The  following  solutions  are  recommended  applied 
w^ith  cloths  saturated  with  the  same : 

Boric  Acid,  saturated  solution.     (St.) 

Carbolic  Acid,  1  drachm  with  half  a  pint  each  of 
alcohol  and  water,  applied  every  alternate  hour 
(Ja.),  or  half  a  drachm  to  a  pint  of  milk;  the  latter 
is  said  to  greatly  relieve.     (Rd.) 


ERYSIPELAS.  285 

Borax,  gss-Oss.     (Hel.) 

Picric  Acid,  6-1000.  This  remedy  has  been  highly 
praised.     (F.) 

Grindelia  Robusta,  2  drachms  of  the  fluid  extract 
with  water  half  a  pint.     ( Al.) 

Resorcin,  2  or  3  per  cent,  solutions.     (F.) 

Hydrastis,  1  part  of  the  tincture  to  5  to  6  of 
water.     (M.  H.) 

Belladonna,  1  part  of  the  tincture,  1  part  of  gly- 
cerine,  8  parts  of   water,  recommended  by  Piffard. 

Veratrum  Viride,  1  drachm  of  the  tincture,  tepid 
water,  2  ounces,  one  of  the  best  local  remedies.   (Ga.) 

Calamine  Lotion.     (M.  W.) 

Glycerite  of  Starch: — This  forms  an  agreeable  sub- 
stitute for  greasy  preparations.     (M.  W.) 

Alcohol: — Cloths  kept  saturated  and  covered  with 
some  impermeable  material.  Reported  to  have  been 
successfully  employed  in  thirty-two  cases,  when  dis- 
ease was  situated  on  the  face  and  other  parts.     (Sj.) 

Vaseline: — For  application  to  the  face  forms  a 
convenient  dressing.     (F.) 

Cosmoline: — Preferable  when  anointment  is  used, 
as  it  interferes  less  with  the  function  of  the  skin. 
(Al.) 

Benzoated  Collodion: — Made  with  equal  parts  of 
the  compound  tincture  of  benzoin  and  collodium.  (B. 
H.) 

Ferric  Perchloride: — 1  per  cent,  solution  in  ether 
is  said  to  act  quickly  in  aborting.     (T.,  96.) 

Salicylic  Acid : — Half  a  drachm  to  a  drachm  with 
cosmoline  1  ounce  has  been  employed  with  satis- 
factory results.     (Al.) 

Bichloride  of  Mercury : — 1—1000  sprayed  on  the 
part  at  a  distance  of  four  inches,  and  repeated  four 


286  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

times  daily,  has  been  successful!}'  employed.  In  us- 
ing this  treatment  the  eyes  should  be  protected  and 
hair,  if  present,  should  be  cut  off.  (Vn.)  Solutions 
of  1-5000  as  a  dressing  have  also  been  employed. 
(St.) 

Method  of  Koch: — Creolin  1  part,  lodoforni  4 
parts.  Lanolin  10  parts.  Applied  not  only  on  the 
affected  area  but  one  inch  bej^ond  on  healthy  skin. 
(Al.) 

Method  of  Hallopeau: — A  mask  of  several  thick- 
nesses of  linen  is  soaked  in  a  solution  of  Sodium  Sali- 
cylate 1-20,  and  applied  over  the  part.  A  rubber 
cloth  is  put  on  over  this  to  prevent  evaporation. 
Relief,  it  is  said,  is  almost  immediate  and  cure  rapid. 
(An.) 

Method  of  ^A«^cefler: — A  simple  piece  of  adhesive 
plaster  an  inch  in  width  and  sufficiently  long  to  sur- 
round the  part  is  applied  an  inch  or  more  from  the 
advancing  border  of  the  disease.  The  firmer  the 
pressure  the  greater  the  chance  of  success,  which  is 
said  to  be  very  marked.  This  procedure  is  preferable 
to  that  of  the  Kraske-Reidel  method.     (B.  H.) 

Carbolic  Acid  Injections: — 1  to  2  percent,  solutions 
are  used  for  injections  in  the  part  surrounding  the 
diseased  surface.  This  method  is  painful  and  liable 
to  cause  abscess,  at  the  same  time  it  has  been  suc- 
cessful.    (Os.) 

Pilocarpine  : — i  grain  doses  hypodermically  inject- 
ed in  the  same  manner  as  carbolic  acid,  until  physio- 
logical effects  are  produced,  have  been  used.     (B.  H.) 

Kraske-Reidel  Method: — This  consists  of  scarifica- 
tion partly  in  the  healthy  and  partly  in  the  diseased 
skin ;  then  the  application  of  gauze  wet  w^ith  a  solu- 
tion of  bichloride  of  mercury  1—1000.    The  method 


ERYSIPELAS,  PHLEGMONOUS-CELLULITIS.         287 

is  painful  and  causes  scars  and  therefore  is  not  suited 
for  use  on  the  face.  It  is  to  be  employed  only  for  the 
more  grave  form  of  the  disease  and  is  not  generally 
commended.     (B.  H.) 

Bichloride  of  Mercury  Injections  : — This  procedure 
is  only  justifiable  A^^hen  the  size  of  the  area  involved 
is  not  sufficiently  great  to  require  enough  of  the  bi- 
chloride to  endanger  poisoning.  The  injections  are 
made  around  the  involved  surface.  Wyeth  says  he  has 
used  a  solution  of  1—500  around  an  erysipelatous 
patch  an  inch  in  diameter  w^ithout  causing  untoward 
symptoms.  As  the  injections  cause  pain,  local  anaes- 
theria  is  necessary.     (W.) 

This  method  is  adapted  to  severe  forms  of  the  dis- 
ease. 

Antistreptococci  Serum  : — As  a  remedy  for  ery- 
sipelas this  agent  is  still  within  the  realm  of  experi- 
mentation. Naturally  it  has  been  employed  in  only 
grave  cases.  The  dose  is  10  c.c,  repeated  once  if 
necessary,  but  rarely  more  than  that.  Some  writers 
urge  the  administration  of  larger  doses.  A  number 
of  successful  cases  have  been  reported.  (P.  M.,  8,  99.) 


ERYSIPELAS,    PHLEGMONOUS- 
CELLULITIS. 

Free  Incision  and  Drainage : — As  soon  as  pus  is 
formed,  incisions  should  be  made  and  drainage  estab- 
lished. Park  says  that  the  treatment  of  threat- 
ened phlegmon  consists  primarily  in  free  incision 
down  to  the  deepest  tissue  involved,   even  to  the 


288  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

bone  itself  if  necessary.  (Pk.)  After  incision  the 
parts  should  cleansed  and  irrigated  with  an  anti- 
septic solution. 

Carbolic  Acid  and  Hydrogen  Peroxide: — Preferable 
in  this  disease  for  irrigation  to  solutions  of  corrosive 
sublimate.     (Den.) 

Antiseptic  Baths: — The  immersion  of  the  parts 
when  possible  in  a  bath  of  hot  weak  antiseptic  solu- 
tion is  beneficial.     (Den.) 

Antiseptic  Fomentations : — After  incision  large 
borated  or  carbolized  fomentations  should  be  ap- 
plied.    (Tre.) 

The  following  is  strongly  endorsed.  Under  its  in- 
fluence with  moist  heat  infiltration  assumes  a  less 
threatening  appearance  and  pus  is  sometimes  ab- 
sorbed : 


Ichthj'ol,  or  Naphthaline, 

ID  parts. 

Resorcin , 

5  parts. 

Mercurial  Ointment, 

40  parts. 

Lanolin, 

50  parts. 

The  proportions  of  the  ingredients  may  vary. 
When  the  skin  is  not  very  sensitive  the  amount  of 
ichthyol  may  be  increased.     (Pk.) 


ERYTHEMA  SIMPLEX. 

Soothing    and    astringent    lotions    are    indicated. 
The  follov^ing  are  serviceable : 


^.    Acid.  Hydrocyanic.  Dil., 

3J. 

Bismuth.  Subnitratis. 

3i-ij 

Aq.  Aurant.  Flav., 
M. 

3iv. 

ERYTHEMA   INTERTRIGO.  289 

Or, 


^. 

Pulv.  Zinc.  Carb. 
Pulv.  Zinc.  Oxidi 
Pulv.  Amyli, 

Prsecipitati, 

Glycerini, 

aa 

3iv. 

Aquae, 

Oss. 

M. 
if 

Acid.  Carbolici, 
Zinc.  Oxidi, 
Glycerini, 

3J- 

Aq.  Rosae  vel  Aq. 

Calcis, 

q.  s.  ad 

^viij. 

(Vn.) 


M.  (B.  H.) 

Dilute  Lead  W^ater  or  Lead  V^ater  and  Lauda- 
num, or  Alcohol  and  water  are  also  usefiil  in  many 
cases.  Powders  are  difficult  to  keep  in  contact  with 
the  skin,  and  ointments,  as  a  rule,  do  not  agree. 
Alkaline  Baths  are  sometimes  serviceable. 

Zinc  Acetate: — 2  grains,  rose  water  1  ounce,  re- 
commended bj"  Tilbury  Fox. 

Bismuth  Subnitrate,  Zinc  Oxide,  with  equal  parts 
of  Starch  or  Lycopodium  powder  or  Talc,  as  dust- 
ing powders.     (Bt.) 


ERYTHEMA  INTERTRIGO. 

Cleanliness  is  the  most  important  feature  of  treat- 
ment. Wash  the  parts  with  a  little  Castile  soap  and 
w  iter,  dry  with  a  soft  towel  and  apply  mild  dusting 
powders  such  as  Starch,  Lycopodium  or  equal  parts 
of  the  latter  with  Zinc  Oxide  or  Buckwheat  Flour, 
Bismuth  Subnitrate  or  Boric  Acid. 
20 


290  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

McCall  Anderson's  Powder: — A  ven,'  useful  com- 
pound.   It  is  composed  as  follows : 

ft.    Pulv.  Camphorse,  3J-ij- 

Pulv.  Amyli, 

Pulv.  Zinc.  Oxidi,  aa  555. 

M. 
It  is  important  that  the  camphor  should  be  an  impalpable  pow- 
der, and  that  the  bottle  should  be  kept  tighth-  corked.     (Al.  j 

Quinine  Oleate: — Besnier  recommends  the  follow- 
ing to  be  rubbed  on  tw^ice  a  da^',  after  which  the 
parts  are  to  be  dusted  with  powdered  starch : 

Quinine  Oleate,  i  part. 

Lanolin,  30  parts. 

Olive  Oil,  30  parts. 

(R.  M-,  6,  22,  99.  j 

Belladonna: — When  the  thighs  and  genitals  are  the 
seat  of  trouble,  and  there  is  some  h^'^perhidrosis,  the 
tincture  may  be  painted  on,  followed  b3'  powdered 
zinc  oxide.     (Vn.) 

Lotions  are  suited  to  cases  of  a  more  obstinate 
character.    The  following  will  prove  satisfactory : 

Lotio Nigra: — Applied  several  times  a  day  followed 
by  dusting  powders.     (Vn.) 

Alum  and  Zinc  Sulphate: — Recommended  b3'  the 
late  Dr.  Tilbury  Fox  as  follows : 

5fc.    Zinc.  Sulphatis,  gr.  x. 

Aluminis,  gr.  xx. 

Glycerini,  3J. 

-\q.  Rosee,  Jviiss. 
M. 

Bland  ointments  may  be  of  service  such  as  Zinc 
Oxide  1  drachm  with  Ung.  Aq.  Rosae  1  ounce.  (B. 
H.) 


FAvrs.  291 

Cerates  or  glvceroles  of  Calendula,  Iodoform,  Zinc 
Oxide,  Hydrastine,  Boric  Acid,  Carbolic  Acid,   etc. 

(Bt.) 


FAVUS. 

Great  patience  and  perseverance  are  necessary  for 
the  successful  treatment  of  this  obstinate  disease. 
.  The  hair  should  be  cut  short,  after  which  all  crusts 
may  be  removed  with  poultices  and  oil  or  hot  water 
and  soap,  as  in  pustular  eczema.  Then  epilation 
should  be  practiced,  pulling  the  hair  out  not  only 
firom^  the  patches,  but  also  for  about  half  an  inch 
around  them;  this  should  be  repeated  every  week 
until  no  trace  of  redness  exists.  (Ja.)  After  this  the 
scalp  is  ready  for  a  parasiticide.  The  following  are 
of  service: 

Heat : — The  disease  being  sensitive  to  high  temper- 
ature the  following  has  proved  successful:  Com- 
presses wet  wnth  a  bichloride  of  mercury  solution  1- 
1000,  are  applied  to  the  part,  and  over  this  a  series 
of  Leiter's  tubes  through  which  hot  water  at  a  tem- 
perature of  14-0^  to  150^  F.  is  run.  Applications  may 
be  continued  for  twelve  hours  daily  for  eight  davs. 

(Sj.) 

Chrysarobin: — 10  to  20  grains  with  lanoline,  1 
ounce,  forms  one  of  the  most  effective  applications. 
(B.  H.) 

Tr.  Iodine: — Freely  applied,  recommended  by 
Besnier. 

Resorcin: — Used  by  Crocker,  1  drachm  with  1 
ounce  of  lanoline  or  oil. 


292    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Method  of  Besnier  and  Doyon: — The  follo^ng 
line  of  treatment  is  recommended  : 

Cut  off  the  hair  around  the  patches;  then  cover 
the  whole  head  with  equal  parts  of  soft  soap  and 
lard,  allowing  this  to  remain  t^vo  or  three  hours; 
then  wash  off  with  warm  water  and  cover  the  head 
during  the  night  with  a  rubber  cap.  The  following 
morning  the  head  is  washed  clean  and  bathed  with  a 
solution  of  boric  acid  25-1000,  and  covered  with 
bora  ted  lint  soaked  in  the  following : 

Sodium  Salicylate,  25  parts. 

Sodium  Bicarbonat.,  xo  parts. 

Water,  1000  parts. 

Over  this  the  rubber  cap  is  placed.  After  a  fe^w 
daj'S  the  scalp  will  be  clean  and  the  dermatitis  will 
have  disappeared.  Epilation  must  now  be  practiced, 
the  hair  being  extracted  from  the  patches  for  an  inch 
around  them.  The  head  to  be  kept  covered  with  the 
rubber  cap.  In  the  evening  an  antiseptic  ointment, 
such  as 

Bal.  of  Peru  or  Oil  of  Cade,  2  to  5  parts. 

Salicylic  Acid,  Resorcin,  each,  i  to  5  parts. 

Sulphur  Precipitate,  5  to  15  parts. 

Lanolin,  Vaseline,  Lard,  equal  parts  of  each  to  make  100. 

Every  morning  wash  the  scalp  with  tar  soap,  soak 
each  favic  patch  w^ith  the  following : 

Alcohol,  90  per  cent.,  100  parts. 

Acetic  Acid  (Crystals),  >(  to  i  part. 

Boric  Acid,  2  parts. 

Chloroform,  5  parts. 

Then  each  patch  is  to  be  covered  with  mercurial 
plaster.     (Ja.) 

The  following  other  applications  are  recom- 
mended : 


FELON.  293 

Salicylic  Acid,  3  to  5  per  cent..  Carbolic  Acid, 
gtt,  xv-o-sj  of  Olive  Oil,  Naphthol  Oil,  1  per  cent., 
Sodium  Hyposulphite,  gij— §j.  (B.  H.)  Naphthol  5 
percent,  ointment  (B.),  Hydrarg.  Oxid.  Flav.  gss-^j. 
Ung.  Sulphur,  Sulphurous  Acid,  saturated  solution 
(Vn.) 

Resorcin,  Mercurial  or  Hydronaphthol  Plasters 
are  to  be  used  for  constant  application  to  favus  of 
the  nails.     (Ja.) 

When  situated  on  non-hairy  parts  the  disease 
usually  3aelds  to  the  application  of  antiparasitic 
ointments  such  as  those  mentioned. 

After  apparent  cure  the  patient  should  be  carefully 
watched,  and  any  red  point  that  appears  is  evidence 
that  the  disease  is  returning,  and  that  treatment 
should  be  at  once  resumed. 


FELON. 

Alkalies: — A  poultice  of  hard  wood  ashes,  will 
often  abort.     (F.) 

Nitrate  of  Silver  : — A  strong  solution  in  Nitric 
Acid,  ^vill  abort  if  applied  early.     (B.) 

Ichthyol : — Equal  parts  with  water,  has  been  used 
with  excellent  results.     (Al.) 

Leeches ; — May  be  applied  above  the  nail  in  the 
early  stages  with  good  effect.     (Ag.) 

Ung.  Hydrarg.: — Applied  for  ten  minutes  every 
hour  \Yith  poultices  at  other  times.     (R.) 

Iodine : — Will  often  abort  if  applied  as  soon  as 
slight  pain  is  felt.     Paint  the  finger  freely,  or  dip  it 


294  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

into  the  fluid  and  allow  it  to  dr3'  on;  repeat  this 
three  or  four  times  a  day.     (Al.) 

Nitric  Acid: — Painting  the  affected  part  with  the 
fuming  acid  is  said  to  relieve  the  pain  instantly. 
(Rd.) 

Citrine  Ointment: — Has  been  used  with  success, 
(Al.) 

Alcohol: — Serviceable  in  neglected  cases  when  poul- 
tices have  been  long  used ;  equal  parts  with  water 
form  a  convenient  evaporating  lotion:    (Al.) 

Heat: — Fomentations  and  dipping  the  finger  in 
hot  water  will  afford  relief  of  pain  and  hasten  sup- 
puration.    (Bt.) 

Lobelia:  —  A  saturated  compress  of  the  tincture 
kept  constantly  applied  is  said  to  be  efficacious  in 
arresting.     (Hel.) 

Free  Incision: — Imperative  ^vhen  pus  has  formed 
beneath  the  tendons  or  periosteum ;  its  neglect  will 
entail  much  pain  and  possibly  loss  of  the  finger. 
(Hel.) 


GALACTORRHOEA. 

Hot  Cloths : — Applied  for  ten  minutes  and  repeated 
at  intervals.     (G.  J.) 

Pressure : — Cover  the  nipple  with  sterilized  gauze 
and  apply  a  firm  binder ;  the  breasts  w^ill  then  empty 
themselves.     (G.J.) 

Camphorated  Oil: — Will  often  control  the  condi- 
tion; the  heart  should  be  rubbed  with  the  remedy. 
(F.) 

Conium : — An  ointment  of  the  bruised  leaves,  may 


GANGLION.  295 

be  emploved  when  it  is  desired  to  drv^  up  the  milk. 
(Sm.) 


GANGLION. 

Method  of  Duplay: — Wash  and  disinfect  the  skin 
as  for  an  operation,  then  inject  5  to  6  drops  of  Iodine 
into  the  cyst,  the  skin  being  drawn  aside  so  as  to 
form  a  valvular  opening ;  the  contents  are  now  evac- 
uated and  an  antiseptic  dressing  and  pressure  are 
applied.  The  pain  is  slight,  and  a  cure  is  generally 
affected  in  from  five  to  six  days.  In  large  cysts  a 
second  injection  is  sometimes  necessary.  The  syringe 
should  be  rendered  aseptic.  This  method  is  described 
as  safe,  simple  and  invariably  successful.     (T.,  96.) 

Subcutaneous  Rupture: — Striking  the  cyst  a  blow^ 
is  a  time-honored  procedure.     (Pk.) 

Other  methods  are  Subcutaneous  Division  by  a 
small  flat  needle  and  Injections  of  Iodoform.  (Mc.) 
Whatever  method  is  employed  pressure  and  the  use 
of  splints  are  recommended.     (Pk.) 


GANGRENE. 

MOIST  GANGRENE. 

Apply  cotton  batting  several  inches  thick  around 
the  part,  and  cover  with  oiled  silk  or  rubber  protect- 
ive ;  care  should  be  taken  that  there  is  no  pressure. 
Hot  water  bags  and  bottles  are  deprecated  on  ac- 
count of  the  capillary  contraction  these  agents  pro- 
duce.    As  death  of  the  part    progresses  all  disor- 


296  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

ganized  tissues  which  can  be  easily  removed  should 
be  cut  away  Avith  the  scissors,  and  an  antiseptic 
dressing  applied,  such  as  gauze  soaked  in  sublimate 
solution  1-500.     (W.) 

Carbolic  Acid:  —  1  part,  glycerine  4  parts;  lint 
soaked  in  this  solution  and  applied  to  gangrenous 
surfaces  w^as  used  by  Lister.  The  following  has  been 
found  effective : 

Carbolic  Acid,  752  gr. 

Caustic  Soda,  124  gr. 

Water,  i  pint. 

Lint  soaked  in  1  part  of  this  mixture  w^ith  4  of 
w^ater  and  kept  constant^  applied  and  covered  with 
oiled  silk,  will  be  found  effective  in  relieving  the  pain 
and  destroying  the  fetor.  The  solution  may  be  made 
more  dilute  if  desired.     (M.  H.) 

Hydrarg.  Bichlorid.: — The  stronger  solution  may 
be  emplo3^ed  for  cleansing.  Gauze  soaked  in  a  solu- 
tion of  1-1000  should  be  laid  around  the  line  of  de- 
marcation as  soon  as  formed  to  guard  against  septic 
absorption.     (W.) 

Poultices: — Linseed  meal,  charcoal,  yeast  or  car- 
rots are  sometimes  of  service  in  removing  sloughs. 
(Bt.) 

Free  Incisions : — Indicated  in  phlegmonous  or 
other  inflammations  when  the  tension  is  so  great 
that  gangrene  is  threatened  by  pressure  upon  the 
capilla.ries  and  large  vessels.  The  incision  should 
be  made  parallel  with  the  vessels  and  sufficiently 
deep  to  relieve  tension.     (W.) 

Iodoform  and  Salicylic  Acid : — Among  the  most 
effective  of  the  dusting  powders  after  the  removal  of 
sloughs  to  promote  healthy  granulations.     (B.) 


GANGRENE.  297 

Peat : — Finely  pulverized,  sprinkled  over  gangren- 
ous surfaces  has  been  highly  praised.     (F.) 

DRY  GANGRENE. 

The  affected  part  should  be  wrapped  in  cotton  and 
placed  in  as  comfortable  a  position  as  possible.  (W.) 
If  any  local  treatment  is  required  that  mentioned 
under  the  moist  variety  is  applicable. 

HOSPITAL  GANGRENE. 

As  soon  as  attacked  the  wound  should  be  immedi- 
ately mopped  with  some  escharotic,  the  most  effect- 
ive of  which  are  the  following : 

Bromine : — This  agent  heads  the  list  and  is  to  be 
generally  preferred  to  all  others  (F.);  it  proved  to  be 
most  efficacious  in  the  War  of  the  Rebellion.  If  the 
disease  has  progressed  for  t"wo  days,  and  the  wound 
is  covered  with  the  pulpy  mould  peculiar  to  the 
malady,  it  should  be  scraped  first  with  aVolkmann's 
spoon  and  mopped  \vith  the  bromine.  When  the 
skin  has  become  undermined,  free  incision  should  be 
made  so  as  to  expose  every  part  of  the  action  of  the 
caustic,  and  afterwards  dressed  with  iodoform 
gauze.  In  the  case  of  a  gun-shot  wound  the  entire 
track  must  be  scraped  out  w^ith  a  piece  of  cotton  im- 
mersed with  bromine  and  fastened  on  a  holder.  An- 
aesthesia is  necessary.     (W.) 

Nitric  Acid  : — Ranks  next  to  bromine. 

Chromic  Acid: — Highly  effective ;  it  penetrates  the 
tissues  deeply,  causing  comparatively  little  pain. 

Zinc  Chloride  and  the  Dried  Sulphate  : — The  pow- 
ders are  both  powerful  caustics,  but  the  fact  that 
they  cause  great  pain  should  be  remembered.     (B.) 


298  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Turpentine: — One  of  the  oldest  and  most  efficient 
applications ;  the  mortified  parts  are  first  removed 
with  the  scissors  and  the  remedy  is  applied  directh^ 
by  means  of  cotton  cloths  saturated  with  it.  Fetor 
is  dispelled  sloughing  arrested,  and  but  little  pain 
ensues.     (B.) 

Citric  Acid : — Lemon  juice  dropped  into  gangren- 
ous wounds  which  are  then  covered  with  lint  steeped 
in  a  solution  of  chlorine  is  said  to  have  good  effect. 
(Pt.) 

Resorcin: — A  2  per  cent,  solution  is  reported  to 
have  succeeded  in  arresting  when  other  measures 
failed.     (Al.) 

Camphor: — The  powder,  freely  sprinkled  over  flax- 
seed and  charcoal  poultices,  has  been  used  for  the 
sloughing  surfaces  both  in  this  form  and  senile  or 
dry  gangrene .     ( Al . ) 

Warm  Baths:  —  For  gangrenous  ulcerations,  the 
immersion  of  the  part  continuously  for  about  eight 
hours  in  a  warm  water  bath,  temperature  of  95°  to 
98°,  was  introduced  by  Hutchinson.  After  two  or 
three  sittings  the  sores  are  said  to  assume  a  healthy 
appearance.     (Al.) 

Potass.  Permang.gr.  iij-x-^j  (B.),  and  Labar- 
raque's  solution  (N.),  both  form  useful  dressings  to 
correct  the  fetor. 


GASTRALGIA. 

Lavage : — This  measure  has  been  productive  of 
good  results  in  cases  which  have  resisted  other  ther- 
apeutic measures,  especially  those  which  have  re- 
sorted to  morphine;  the  water  used  warm  has  a 
soothing  effect.     (S.  B.) 


GASTRITIS.  299 

Warm  Baths  even'^  night  for  ten  minutes  and  Far- 
adism  of  the  stomach  should  be  administered  in  con- 
junction with  lavage.     (S.  B.) 


GASTRITIS. 

Lavage : — Is  of  service  in  chronic  gastric  catarrh 
with  excess  of  mucus,  and  in  no  other  condition  has 
it  done  so  much  good.  (Ew.)  Several  quarts  of 
water  may  be  used,  but  not  more  than  one  pint 
should  be  introduced  into  the  stomach  at  once.  The 
morning,  before  breakfast,  is  usually  the  best  time  for 
administration,  but  when  the  mucus  collects  to  a 
large  amount  the  stomach  may  be  w^ashed  out  again 
before  dinner,  directing  the  patient  to  take  a  light 
luncheon.     (S.  B.) 

Lavage  with  Nitrate  of  Silver: — This  is  of  value  in 
long  standing  cases  of  catarrh  with  hj-peracidity. 
The  stomach  is  first  washed  out  with  a  weak  solu- 
tion of  bicarbonate  of  soda,  in  order  to  remove  the 
excess  of  mucus,  then  with  a  warm  solution  of  nitrate 
of  silver,  20  grains  to  the  quart.  Finally  the  organ 
is  douched  repeatedly  with  a  solution  of  chloride  of 
sodium,  45  grains  to  the  quart.  Under  this  treat 
ment  the  digestive  power  of  the  stomach  increases 
and  the  vomiting  and  constipation  disappear.  (T., 
98.) 

Lavage  in  Infants: — For  the  employment  of  this 
measure  in  children  suffering  from  acute  indigestion 
with  fermentation  the  following  directions  will 
prove  useful : 

Lavage  of  the  stomach  meets  with  difficulties  in 
few  instances  only,  with  almost  none  in  infants  and 


300  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

children,  in  whom  a  catheter  No.  25  or  30  French  is 
sufficient.  In  the  adult  the  post-laryngeal  region 
may  offer  an  occasional  obstacle,  which,  however,  is 
overcome  by  patience.  When  the  pharynx  is  too  irri- 
table, or  the  patient  refractory,  the  tube  ma^^  be 
introduced  through  the  larger,  generally  the  right, 
nostril.  When  it  does  not  readily  pass  into  the 
oesophagus  the  patient  should  be  made  to  swallow^ 
when  it  will  glide  down.  An  aqueous  Salt  Solution 
of  7-1000  may  be  run  through  it  from  a  funnel  or  a 
fountain  syringe  which  is  slightly  raised  above  the 
level  of  the  pharynx,  and  lowered  when  the  fluid  and 
stomach  contents  are  to  flow  out.  The  salt  water 
may  be  mixed  with  a  disinfectant,  as  Thymol,  1- 
3000  or  4000,  or  in  cases  of  hyperacidity,  with  Bi- 
carbonate of  Sodium,  1-200  or  500.  The  temperature 
should  be  that  of  the  body  when  this  is  normal, 
somewhat  or  considerably  cooler  when  there  is  a 
high  elevation,  or  warmer  w^hen  there  is  a  reduction 
of  the  body  temperature.  Alcohol  should  not  be 
added  to  the  injection,  because  its  dilution  is  partly 
absorbed  by  the  stomach.  On  the  other  hand,  w^hen 
v^ater  is  injected  without  salt,  it  causes  osmosis  of 
the  body  fluids  into  the  stomach  sometimes  to  such 
an  extent  as  to  visibly  increase  the  amount  return- 
ing from  the  stomach.  The  irrigations  should  amount 
to  100  and  more  c.  cm.  in  the  nursling,  200  or  300  in 
the  child,  500  or  700  in  the  adult.  They  should  be 
repeated  until  they  return  clear.  The  tube  should 
alw^ays  be  withdrawn  quickly  so  as  to  avoid  irrita- 
tion of  the  fauces.     (N.  E.  M.  J.,  5,  99.) 


GINGIVITIS,    SIMPLE.  301 


GINGIVITIS,  SIMPLE. 

Antiseptic  tooth  washes  should  be  used  night  and 
morning,  or  better  after  each  meal.  In  infants  the 
absence  of  cleanliness  is  often  the  cause  of  inflam- 
mation, hence  after  nursing  the  mouth  should  be 
v^ashed  and  patient  should  be  given  a  little  water  to 
drink. 

Nitrate  of  Silver : — 1—500  or  1000  brushed  on  once 
a  day  when  mucous  membranes  are  drj^;  recom- 
mended for  children.     (Hit.) 

Copper  Sulphate  : — The  powder  packed  down  under 
the  edge  of  the  gums  with  a  wooden  point  for  sev- 
eral days  is  useful  in  obstinate  cases ;  then  use  as  a 
mouth  w^ash,  viz.: 

^.    Potass.  Chloratis,  gij. 

Sod.  Biboratis,  5J. 

Potass.  Nitratis,  Jss. 

Tr.  Arnicae,  ^ij. 

Aq.  Rosae,  ad  ^viij. 
M.  (T.,96.) 

Removal  of  Tartar: — Tartar  must  be  most  care- 
fully scaled  ofl";  then  syringe  under  the  gums  with 
hydrogen  peroxide.     (T.,96.) 

Zinc  Chloride: — If  the  tissues  are  turgid,  thickened 
and  inflamed,  apply  with  syringe  30  per  cent,  solu- 
tion under  edge  of  gums.     (T.,  96.) 

A  useful  powder : 

9;.    Cretae  Praeparatae,  ^iv. 

Pulv.  Iridis  Radicis,  Siij- 

Pulv.  Saponis  Alb.,  gvj. 

Ol.  Eucalypti,  jss. 

Otto  Rosae,  Mvij. 
M. 


302  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

If  there  is  much  destruction  of  tissue  apply  every 
four  da^^s  with  a  brush  the  following : 

Jfc.    Ol.  Cinnamoni, 

Ol.  Gaultherise,  aa  ^iv. 

Acid.  Carbolic! ,  3j. 

M.  (T.,96.) 


GLANDERS. 

Excision,  Curettage  and  Cauterization  in  the  cuta- 
neous form  should  be  practiced  as  earh^  as  possible, 
following  with  antiseptic  dressings.  (Pk.)  All  sus- 
picious wounds  and  all  ulcers  should  be  freely  cau- 
terized.   (Q.) 

As  abscesses  form  they  should  be  evacuated  by  free 
incision  and  cleansed  constanth^  with  antiseptic  in- 
jections of  Potass.  Permang.  or  Carbolic  Acid.  (Vn.) 

For  nasal  ulceration,  Iodoform  and  the  allied  dust- 
ing powders;  sprays  of  Bichloride  of  Mercury,  Car- 
bolic Acid  and  Hydrogen  Peroxide.  (Ty.)  Nitrate 
of  Silver  solutions  or  Tincture  of  Iodine  may  be 
used  for  touching  the  ulcers.     (Vn.) 


GLANDS,  ENLARGED. 

Compare  Adenitis. 

Iodine: — Parenchymatous  injections  wath  a  hypo- 
dermic syringe  are  often  exceedingly  valuable,  a  few 
drops  of  the  tincture  being  sufficient.     (F.) 

Carbolic  Acid: — 2  per  cent,  solution  injected  into 
the  glands  which  threaten  to  suppurate  will  often 
prevent  the  formation  of  pus.     (Sm.) 


GLOSSITIS.  303 

Iodoform : — The  officinal  ointment  useful  in  many 
forms  of  enlargement. 

Cadmium  Iodide:  —  The  ointment,  gr.  x— xx— 5J,  in 
chronic  enlargements.     (Sm.) 

Ichthyol: — As  an  ointment,  3— iij— 5J,  was  recom- 
mended bj^  Agnew^. 

Zinc  Iodide: — ^3J-sj,  as  a  simple  ointment.     (Sm.) 

Mercury: — The  ointment  of  the  red  oxide  often  has 
striking  effect  in  reducing  simple  hypertrophy  of  the 
thyroid  gland,  enlarged  spleen,  or  ague  cake.  (B.) 
Calomel,  3J  wit  hmorphia  sulphate,  gr.  j— ij— §j,  is  use- 
ful in  reducing  swelling  and  arresting  abscess.    (Sm.) 

Conium: — The  ointment  is  useful  in  reducing  scrof- 
ulous glands,  enlarged  mammarj^  glands,  enlarged 
liver  and  spleen  and  goitre.     (Sm.) 

Galvanism: — Often  of  service  in  reducing  chronic 
enlargement  of  cervical  gland;  the  current  may  be 
medicated  with  iodine  or  ammonium  chloride.  The 
positive  pole  is  placed  on  the  back  of  the  neck  and 
the  negative  over  on  the  gland.  Rapid  resolution,  it 
is  claimed,  will  take  place.     (Terry.) 


GLOSSITIS. 


SUPERFICIAL. 


Cleanliness  is  most  important.  All  local  causes  of 
irritation,  such  as  decayed  teeth,  ill-fitting  artificial 
teeth  should  be  removed. 

Ice  : — Will  prove  grateful  and  assist  in  allaying  in- 
flammation.    (Gn.) 

Bismuth  Subnitrate: — 5  grains  to  rose  w^ater  1 
ounce,  with  the  addition  of  a  little  glycerine,  is 
useful  and  agreeable. 


304  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Mouth  Washes  containing  Boric  Acid,  Hydrastis, 
Thymol,  etc.,  are  beneficial.    See  Aphthse. 

PARENCHYMA  TO  US. 

This  form  requires  more  active  treatment. 

Deep  Scarification : — Indicated  if  the  tongue  be- 
comes alarmingly  oedematous.     (An.) 

Leeches  : — Applied  between  the  hyoid  arch  and  the 
angle  of  the  jaw  in  conjunction  with  scarification 
are  of  great  service  in  relieving  swelling.     (An.) 

Steam  Atomization: — Medicated  vapors,  such  as 
those  of  Ammonium  Chloride  or  Compound  Tinct- 
ure of  Benzoin,  favor  resolution.     (An.) 

Incision: — This  may  be  demanded  even  before  the 
advent  of  suppuration ;  the  incisions  should  be  made 
on  the  superior  surface  of  the  tongue  on  either  side  of 
the  median  line.  (Gn.)  When  incision  is  followed  b^^ 
the  vapor  of  hot  water  great  relief  is  obtained. 

Tracheotomy: — May  be  required  if  incision  does 
not  relieve,  though  it  is  rarely  called  for.     (An.) 

For  treatment  of  Glossitis  Dessicans  and  Fissures, 
see  Fissure  of  the  Tongue. 


GLOTTIS,  CEDEMA  OF. 

See  OEdema  of  the  Larynx. 

GOITRE,  SIMPLE— BRONCHOCELE. 

Iodine : — The  tincture  has  been  used  ^vith  better  re- 
sults in  the  cystic  than  in  the  fibrous  variety ;  8  to 
10  drops  may  be  thrown  into  the  substance  of  the 


GOITRE,  SIMPLE — BRONCHOCELE.  305 

tumor  in  different  parts  every  three  to  five  days. 
Marked  elevation  of  temperature  accompanied  by 
pain  and  stiffness  of  the  neck  are  indications  for  sus- 
pending treatment.  (Agnev^.)  GosseHn's  use  of 
iodine  in  treating  cystic  goitre  consists  of  incising 
the  skin  over  the  gland,  introducing  a  small  trocar 
and  evacuating  the  contents  of  the  cyst,  then  cleans- 
ing the  cavity  vv4th  sterilized  vv^ater  and  injecting  1 
drachm  of  tincture  of  iodine ;  this  is  permitted  to  re- 
main in  five  minutes;  should  its  discharge  be  fol- 
lowed by  blood  a  second  injection  is  made.  (Pp.) 
Injections  of  10  to  15  drops,  repeated  every  two  or 
three  days  until  ten  injections  have  been  given  (L. 
T.),  or  20  to  30  minims  of  a  solution  of  1—12  of 
alcohol  injected  twdce  a  week,  a  new-  point  being 
selected  each  time,  care  being  observed  not  to  wound 
any  vessel,  are  other  methods  of  application. 

Iodoform: — Also  employed  in  several  ways ;  Mose- 
tig  advised  as  a  substitute  for  iodine  the  following : 
Iodoform,  1  part  ether,  5  parts,  olive  oil,  9,  or  in 
the  proportion  of  1,  7,  7.  (Garre.)  This  is  free  from 
danger.  (L.  T.)  It  is  also  used  hypodermically  with 
good  results  in  solution  or  stferile  emulsion,  a  10  per 
cent,  solution  being  employed,  and  from  tv^o  to  three 
drops  injected  in  the  base  of  the  growth  (F.);  as  an 
ointment,  a  drachm  and  a  half,  with  benzoated  lard 
1  ounce,  rubbed  in  for  fifteen  or  twentj^  minutes, 
night  and  morning,  a  piece  of  lint  smeared  with  the 
same  is  then  laid  on  and  covered  w^ith  oiled  silk. 

(Pp.) 
Red  Iodide  of  Mercury: — A  piece  of  the  ointment 

the  size  of  a  pea  is  rubbed  over  the  surface  of  the 

goitre  until  sensitiveness  is  produced ;  in  a  few  days 

this  procedure  is  repeated,  and  continued  with  neces- 

21 


306  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

sary  intermission  for  weeks  and  even  months.  The 
rays  of  the  sun  are  said  to  help  the  action.  (L.  T.) 
Another  method  of  appHcation  is  to  employ  an  oint- 
ment of  the  strength  of  15  grains  of  the  mercury  to 
1  ounce  of  ointment  base.  A  small  portion  of  this  is 
rubbed  over  the  goitre,  which  is  then  exposed  to  the 
raj-^s  of  the  sun  as  long  as  the  patient  can  bear  it. 
Within  half  an  hour  a  smarting  sensation  is  felt,  and 
at  the  end  of  an  hour  a  blister  will  appear  which 
should  be  treated  in  the  usual  manner.  The  effect  of 
the  drug  continues  long  after  the  blister  has  healed. 
(Al.) 

Yellow  Iodide  of  Mercury,  gj,  Oleic  Acid,  ^ix,  rec- 
ommended b\'  Lefferts  for  fibrous  variety. 

Perchloride  of  Iron: — Was  used  by  Mackenzie  in 
place  of  iodine  in  cystic  goitre ;  1  part  to  4  of  w^ater, 
injection  of  1  to  2  drachms,  according  to  the  plan  of 
Gosselin ;  the  injection  is  allowed  to  remain  in  three 
days ;  if  the  discharge  is  bloody  it  is  repeated,  if  pur- 
ulent the  canula  is  allowed  to  remain  for  drainage. 
During  this  treatment  the  neck  is  covered  with  flax- 
seed poultices.     (Pp.) 

Ergot: — Preferable  to  iodine  in  the  vascular  varie- 
ties ;  10  to  20  drops  of  the  fluid  extract  h^'podermic- 
ally  have  been  employed.     (Pp.) 

Electrolysis:  —  Effective  to  a  certain  extent,  the 
first  applications  being  followed  by  a  decrease  in  the 
size  of  the  tumor,  which  is  less  and  less  marked  after 
subsequent  applications.  Large  needles,  insulated 
to  within  a  short  distance  of  the  points,  are  intro- 
duced into  the  substance  of  the  gland,  these  are  at- 
tached to  the  negative  pole ;  the  positive  pole  is  at- 
tached to  a  large  flat  electrode  which  is  applied  over 
the  gland  a  short  distance  from  the  needle.   A  current 


GOITRE,   EXOPHTHALMIC.  307 

of  from  5  to  10  milliamperes  may  be  applied  for  five 
minutes.     (Gn.) 

Stronger  currents  have  been  advised  (Dickson), 
being  regarded  as  useful  in  the  earlier  stages  of  the 
disease.  A  current  of  100  to  150  milliamperes  is  ap- 
plied for  ten  minutes  at  a  time,  a  clay  electrode  is 
placed  over  the  goitre  and  a  large  wire  gauze  elec- 
trode between  the  shoulders.  When  puncture  of  the 
growth  is  made,  a  current  of  50  milliamperes  is  ap- 
plied for  eight  minutes.  Another  method  consists  of 
aspiration  of  the  cyst,  followed  by  injection  of  a  hot 
solution  of  sodium  chloride,  sj-^ij,  and  the  applica- 
tion through  the  canula  of  a  current  of  50  to  100 
milliamperes  for  ten  minutes ;  the  salt  solution  is 
then  withdrawn.  Rockwell  objects  to  these  strong 
currents.     (Sj.) 

Extirpation: — When  all  other  means  have  failed, 
and  the  growth  is  large  and  causes  dangerous  symp- 
toms, this  procedure  must  be  considered.  Better  re- 
sults are  obtained  from  operative  treatment  than 
from  medical,  but  the  high  rate  of  mortality  contra- 
indicates  its  use  until  after  all  other  measures  have 
proved  unavailing.  (L.  T.)  See  paragraph  on  ex- 
tirpation under  Exophthalmic  Goitre. 


GOITRE,    EXOPHTHALMIC. 

Leiter's  Coil: — Applied  over  the  lower  part  of  the 
neck  and  upper  part  of  the  sternum,  according  to 
Osier,  is  more  successful  than  any  other  treatment. 
It  relieves  the  rapid  heart  action. 

Ung.  Hydrarg.  Oxid.  Rub.:  —  Employed  as  de- 
scribed in  simple  goitre  or  bronchocele  has  also  been 
used  for  this  affection.     (L.  T.) 


308         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Electricity: — Galvanism,  25  to  75  milliamperes,  is 
recommended  by  Rockwell,  using  sculptor's  claj^  for 
electrode ;  the  positive  pole  is  placed  over  the  sixth 
cervical  vertebra  and  the  negative  over  the  region  of 
the  solar  plexus;  the  positive  pole  is  shifted  to  the 
goitre  during  the  seance ;  the  duration  of  application 
is  from  tv^o  to  five  minutes.     (L.  T.) 

Faradism ;  positive  pole  on  the  neck  over  the  caro- 
tid arterj'^  at  the  level  of  the  angle  of  the  jaw  and  the 
border  of  the  stemo-cleido-mastoid  muscle,  on  each 
side;  tlie  negative  to  the  orbicularis  palpebrarum 
muscle,  thyroid  gland  and  preecordium  near  the  ster- 
num at  the  line  of  the  third  intercostal  space ;  appli- 
cation being  made  to  these  localities  in  succession. 
(L.  T.) 

The  seance  should  occupy  about  six  to  twelve 
minutes,  and  the  course  of  treatment  continued  from 
six  to  twelve  months.  Electrical  treatment  should 
be  tried  for  more  than  three  or  four  months. 

Hydrotherapeutics: — Act  favorably  in  some  cases; 
packing,  needle  baths,  and  sea  baths  combined 
-with  galvanism  and  massage,  have  had  good  efiect. 
Cold  sponge  baths,  tepid  baths,  hip  baths.  (An.) 
Mustard  to  the  feet  with  cold  to  the  thj^roid  gland 
are  also  methods  which  are  worthv  of  consideration. 
(Gn.) 

Removal  of  nasal  hypertrophies  has  cured  a  few 
cases.  Change  of  climate  and  moderate  elevation 
have  beneficial  effects  in  cases  not  too  far  advanced. 
Rest  and  freedom  from  excitement  are  essentials  to 
successful  treatment. 

Extirpation: — Though  statistics  show  somewhat 
varying  results,  the\^  warrant  the  opinion  that  if 
medical  treatment  has  failed  and  the  sj^mptoms  are 


GOUT.  309 

urgent  an  operation  should  be  performed.  It  should 
be  borne  in  mind  that  the  entire  extirpation  of  the 
gland  is  liable  to  be  followed  by  myxoedema.  (An.) 
Ligation  of  the  Thyroid  Arteries: — This  procedure 
has  been  employed  in  some  cases ;  its  preference  to 
extirpation  is  a  matter  to  be  decided  by  the  operator 
according  to  the  indications  of  each  case.     (An.) 


GONORRHCEA. 

See  Acute  Urethritis. 

GOUT. 
ACUTE  GOUT. 

Local  treatment  is  usually  confined  to  wrapping 
the  part  in  flannel  or  cotton  batting  and  the  applica- 
tion of  alkaline  solutions  and  anodynes  such  as  the 
following : 

9^.    Atropiae,  gr.  iij. 

Morph.  Hydrochloratis,  gr.  xv. 

Acid.  Oleici,  ^j, 

M. 

Sig.     Paint  on  tJie  painful  parts  with  a  large  camel's  hair 
brush  and  cover  with  cotton  and  towel  bandage.     (H.) 

Or, 

9:.    Lin.  Belladonnae,  ^"j- 

Morph.  Sulph.,  gr.  x. 

M. 
Sig.     Of  this,  use  i  tablespoonftd  to  half  an  oxrnce  of  hot  water 

and  apply  every  two  hours  on  lint,  covering  with  oiled 

silk.     (H.) 


310    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Hot  Mustard  Foot  Baths  are  of  service  and  should 
be  employed  in  retrocedent  gout.     (H.) 

The  following  has  been  reported  as  effective :  Take 
half  an  ounce  of  Iodide  of  Potassium  dissolved  in  8 
ounces  of  Rectified  Spirits,  add  1  ounce  of  Soap  Lin- 
iment, then  half  a  drachm  each- of  Oil  of  Cloves  and 
Oil  of  Cajaput;  a  cloth  soaked  in  this  mixture  is 
wrapped  around  the  affected  part  and  covered  with 
protective  and  bandaged.  This  acts  as  a  powerful 
counter-irritant  and  the  inflammation,  it  is  claimed, 
is  subdued  in  from  twelve  to  twenty-four  hours.  The 
treatment  appears  to  have  been  employed  in  robust 
cases.     (T.,  98.) 

CHRONIC  GOUT.    See  Arthritis. 


GUMBOIL. 

A  roasted  Fig  applied  as  hot  as  can  be  borne  to  the 
inflamed  gum  will  often  afford  relief.  A  small  por- 
tion of  Chamomile  Flowers  or  a  Raisin  dipped  in 
hot  watei",  the  former  for  convenience  placed  in  a 
little  lace  bag,  similarly  applied,  are  also  effective. 
When  pus  has  formed  it  should  be  evacuated  by  free 
incision.    No  poultice  should  be  placed  on  the  face. 


GUMS,  SPONGY  AND  ULCERATED. 

Alum : — Excellent  when  the  gums  are  spongy,  with 
tendency  to  recede  from  the  teeth ;  it  may  be  advan- 
tageously combined  as  follow^s : 


H^MATEMESIS.  311 

9^.    Aluminis,  5j. 

Tr.  Cinchon.,  ^ss. 

Tr.  Myrrhse,  gij. 

Mel.  Rosae,  ^ij. 

Vini,  Oj. 
M. 
Sig.     As  a  mouth  wash.  (B.) 

Tannin : — Same  indications  as  for  alum  ;  also  use- 
ful in  mercurial  salivation,  viz.: 

9;.    Acid.  Tannici,  3]. 

Mel.  Rosae,  ^ij. 

Aquse,  |vj. 

M. 
Sig.     As  a  mouth  wash.  (B.) 

Tannate  of  glycerine  applied  with  a  brush  also 
effective.     (Sn.) 

Chromic  Acid : — One  of  the  best  applications  when 
the  gums  tend  to  ulceration  and  retraction  in  scrofu- 
lous cases  and  after  mercurial  salivation.     (N.) 

See  Stomatitis  for  further  formulae,  as  many  of  the 
mouth  washes  under  that  head  are  also  applicable 
to  this  condition. 


H^MATEMESIS. 
See  also  Haemoptysis. 

The  application  of  a  broad  flat  Ice  Bag  over  the 
epigastrium,  together  with  the  subcutaneous  admin- 
istration of  Ergotine,  will  generally  prove  effective. 


312  DIGEST   OF   EXTERNAL  THERAPEUTICS. 


HEMOPTYSIS. 

The  patient  should  be  placed  in  the  recumbent  post- 
ure, with  head  and  shoulders  elevated.  He  must  be 
kept  absoluteh'  quiet  and  not  allowed  to  speak  ex- 
cept when  necessary. 

Ergot  or  Ergotine: — Subcutaneously  administered 
is  generally  employed.     (Gn.) 

Morphia: — One  of  the  most  eflfective  remedies  in 
dangerous  cases ;  it  must  be  given  hj^podermically  in 
full  doses,  %  grain  two  or  three  times  in  twenty -four 
hours  for  an  adult,     (Gn.) 

Liq.  Ferri  Subsulphatis: — Spraj^s  of  a  solution  of 
1  drachm  to  8  ounces  of  water,  caused  to  enter  the 
throat  with  each  inspiration,  will  often  arrest,  not- 
withstanding so  little  will  pass  the  rima  glottidis. 
(B.) 

Ice  to  the  nape  of  the  neck  and  chest  (Rd.),  also  to 
the  testicles  or  labia.  (Sj.)  Ether  Spray  to  the  spine 
and  chest.     (Bt.) 


HiEMATURIA. 

Local  measures  can  only  be  of  service  when  the 
bladder  itself  is  the  source  of  the  bleeding,  in  this 
case,  Nitrate  of  Silver,  ^4  gr.— §j,  as  a  wash  will  prove 
valuable.     (Al.) 


HiEMORRHAGrE. 

Local  stringents  and  styptics :   Alum,  Agaric,  Al- 
cohol, Antipyrin.  Creolin,  the  latter  in  2  to  3  per 


HEMORRHAGE.  313 

cent,  solution  for  haemorrhage  from  mucous  mem- 
branes; Ice,  Oil  of  Turpentine  for  haemorrhage  after 
removal  of  tonsils  or  extraction  of  teeth;  Styptic 
Cotton,  Tannic  Acid,  Cold  Water,  Hot  Water, 
Hamamelis,  Monsel's  Solution,  and  Tr.  Ferri 
Chloridi. 

Actual  Cautery: — Of  inestimable  value  is  arresting 
haemorrhage  from  vessels  not  possible  to  ligate. 

Ergot  or  Ergotine : — Subcutaneously,  the  fluid  ex- 
tract of  the  former,  or  better  the  following  solution 
of  the  latter : 

9;.    Ergotinae,  gr.  xxx. 

Glycerini  (neutral), 

Aquae,  aa  ^ss. 

M. 
Sig.     Dose,  15  minims.     (T.,96. ) 

Aqua  Animonise: — 1  to  2  drachms  with  an  equal 
amount  of  water  subcutaneously  injected  is  advised 
w^hen  thrombosis  of  a  large  venous  trunk  tends  to 
form,  as  for  example  in  the  pulmonary  artery  after 
uterine  haemorrhage.     (B.) 

Ether : — Subcutaneous  injection  of  1  drachm  into 
the  thigh  as  a  stimulant.     (B.) 

Saline  Injections: — These  are  indicated  in  all  cases 
when  life  is  threatened.  Simple  normal  saline  an- 
swers all  purposes.  More  complex  solutions  are  also 
employed,  some  of  w^hich  are  as  follows : 

9;.    Sodii  Chloridi,  gr.  1. 

Potassii  Chloridi,  gr- "]• 

Sodii  Sulphatis,  gr.  iiss. 

Sodii  Phosphatis,  gr.  ij. 

Sodii  Carbpnatis,  ;^  gr.  iiss. 
M. 

Sig.     Add  the  entire  powder  to  a  pint  of  water  and  inject  at  a 
temperature  of  looto  i20  degrees. 


314  DIGEST   OF   EXTERNAL   THERAPEUTICS. 


An  other  formula  is  as  follows : 

^. 

Sodii  Phosphatis, 

, 

Sodii  Chloridi, 

aa 

3ij- 

Aquae, 

Oij. 

M. 

Sig, 

Inject  subcutaneously 

1}^  pints 

into  the 

thigh. 

(T.,  96.) 

For  technique  and  methods  of  administration  of 
saline  infusions  see  Normal  Saline  Solution,  Appen- 
dix II. 

HEMORRHAGE  FROM  BONE. 

Yellow  Wax: — A  convenient  method  of  arresting 
bleeding  from  cut  ends  of  bones  after  amputation 
consists  in  forcing  a  small  bit  of  w^ax  into  the  can- 
cellated structure.     (Al.) 

HEMORRHAGE  IN  DENTISTRY. 

Gelatin  Injections: — Haemostatic-anaesthetic  solu- 
tions are  of  much  value  in  dentistry  to  stay  pain  and 
check  haemorrhage.  M.  A.  Legrand,  availing  himself 
of  recently  published  reports  concerning  the  haemo- 
static action  of  gelatin,  has  devised  the  following 
solution : 


Gelatini, 

gr.  xxj. 

Sodii  Chloridi, 

gr.  X. 

Acid.  Carbolici,  Crys., 

gr.  iss. 

y9-Eucainae, 

gr.  X. 

Cocain.  Hydrochloratis, 

gr.  ivss. 

Aq.  Destill., 

q.  s.  ad 

3  XXV. 

This  is  injected  inside  the  root  of  the  tooth  to  be 
extracted.  The  result  is  not  only  anaesthesia  but 
arrest  of  haemorrhage.  It  has  been  emploj'ed  with 
success  in  one  case  of  haemophila  in  extracting  two 


HEMORRHAGE.  315 

teeth  at  the  same  sitting.  In  regard  to  sterihzation 
of  this  solution,  attention  is  called  to  the  fact  that 
heat  changes  cocaine.  A  series  of  experiments  with  a 
1  per  cent,  solution  of  cocaine  controlled  by  a  similar 
solution  in  boiled  water  were  instituted;  the  result 
was  as  follows:  The  gelatin  heemostatic-anassthetic 
solution  was  heated  for  ten  minutes  in  a  moist  heat 
at  100°  C.  and  found  to  retain  its  properties.  The 
same  solution  was  again  put  through  fifteen  minutes 
of  moist  heat  at  104°  C,  and  again  without  loss  of 
aneesthetic  properties.  In  a  third  trial  the  solution 
was  heated  to  120°  C.  for  twelve  minutes,  and  re- 
mained anaesthetic.  The  same  solution  was  decom- 
posed when  subjected  to  a  corresponding  amount  of 
dry  heat.     (N.  R.,  2,  24,  99.) 

HEMORRHAGE  FROM  THE  LARYNX. 

The  following  should  be  applied  by  means  of  the 
laryngeal  atomizer : 
Liq.  Ferri  Subsulphatis,  gr.  x-|j. 
Acid.  Tannicum,  gr.  x— 5J. 
Argenti  Nitras,  gr.  x— §j. 

HEMORRHAGE,  POST-PARTUM. 

Immediately  pass  the  hand  into  the  uterus  and 
turn  out  all  clots  or  fragments  of  the  placenta,  clear- 
ing the  cavity  of  its  entire  contents.  Grasp  the  fun- 
dus with  one  hand,  previously  dipped  into  ice  water, 
if  this  can  be  done  without  delay,  hold  the  uterus 
firmly  and  press  it  down  into  the  iliac  fossa,  and  as 
quickly  as  possible  inject  a  stream  of  water  at  a  tem- 
perature of  110°  to  120°  F.  If  delay  will  be  caused  in 
obtaining  hot  water  use  cold,  or  pass  into  the  uterus 


316  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

a  piece  of  ice.  While  this  is  being  done  an  attendant 
should  raise  the  foot  of  the  bed  so  that  the  hips  will 
be  elevated.  After  the  hemorrhage  has  been  suffi- 
ciently controlled,  the  lower  extremities  should  be 
tied  snugly,  but  not  tight,  with  bands,  and  a  com- 
press and  binder  applied  over  the  uterus.    (Ga.,  Ply.) 

Turpentine : — A  piece  of  lint  saturated  with  the 
remedy  carried  directly  into  the  uterus,  so  as  to  be 
in  contact  with  the  inner  surface,  will  act  as  a  stimu- 
lant, produce  contraction,  and  instantly  check  h£em- 
orrhage.     (T.,  98.) 

Tr,  Iodine,  Tr.  Matico  and  Vinegar  applied  to  the 
cavity  of  the  uterus  are  effective  for  arresting  haem- 
orrhage.    (Ply.) 

The  foUoAving  method  of  applying  Pressure  was 
recommended  by  Playfair :  Insert  the  fingers  into  the 
posterior  cul-de-sac  of  the  vagina  and  apply  pressure ; 
then  with  the  other  hand  make  counter  pressure  over 
the  abdomen ;  thus  the  anterior  and  posterior  walls 
of  the  uterus  are  pressed  together.     (Ply.) 

If  alarming  symptoms  persist.  Compress  the  Ab- 
dominal Aorta,  to  the  left  of  the  spine,  on  a  line  with 
the  umbilicus.     ( Ply. ) 

Perchloride  of  Iron : — When  everything  else  has 
failed,  as  a  last  resource  inject  a  solution  of  iron  into 
the  uterine  cavity,  using  liq.  ferri  perchloridi,  1  part 
to  6  parts  of  water,  or  2  drachms  of  the  perchloride 
in  a  pint  of  water.     (Ply.) 

Faradism  : — If  a  battery  should  happen  to  be  at 
hand,  apply  one  pole  to  the  uterine  cavity  and  the 
other  over  the  abdomen.  This  will  produce  contrac- 
tion. 

Subcutaneous  injections  of  Ergot  or  Ergotine  and 
Intravenous  or  Subcutaneous  Saline  Injections,  as 


HEMORRHAGE.  317 

mentioned  under  the  head  of  haemorrhage,  are  all  in- 
dicated in  this  condition.  See  Normal  Saline  Solu- 
tion, Appendix  II. 

HEMORRHAGE  FROM  THE  RECTUM. 

The  rectum  should  be  examined  by  means  of  a  spec- 
ulum, and  the  bleeding  point  ligated  or  cauterized 
with  the  Paquelin  cautery.  In  case  the  point  cannot 
be  located,  packing  must  be  resorted  to.  Mr.  Ailing- 
ham's  method  for  this  procedure  is  as  follows :  Take 
a  cone-shaped  sponge  and  pass  a  strong  ligature 
through  it  near  the  apex;  it  is  then  brought  back 
so  that  the  apex  is  held  in  the  loop;  the  sponge 
dampened,  squeezed  out,  and  dusted  with  an  astrin- 
gent powder,  preferably  iron,  is  introduced  by  the  in- 
dex finger,  apex  first,  and  carried  up  five  inches ;  the 
ends  of  the  ligatures  should  extend  outside  the  anus ; 
the  rectum  below  the  sponge  is  now^  packed  with  cot- 
ton and  dusted  over  with  an  astringent  powder ;  the 
ligatures  are  then  seized  and  pulled  down  with  one 
hand  and  pushed  up  with  the  other.  Attention  is 
called  to  the  fact  that  when  it  becomes  necessary  to 
pack  the  rectum  it  should  be  done  w^ith  great 
thoroughness,  so  that  not  a  single  point  shall  be  ex- 
empt from  pressure. 

If  it  is  intended  to  leave  the  packing  in  for  some 
time  it  is  advisable  to  pass  through  the  apex  of  the 
sponge  a  large  stiff  catheter  so  as  to  allow  the  escape 
of  flatus  and  fluid  faeces.     (K.) 

Irrigation  with  very  hot  or  cold  astringent  solu- 
tions are  effective,  such  as  Alum  Water  or  infusion 
of  Black  Oak  Bark ;  simple  Hot  Water  with  com- 
pression is  also  satisfactory. 


318  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Local  treatment  for  rectal  haemorrhage  may  be 
summed  up  as  consisting  of  Ligation,  Cauterization, 
Torsion,  Compression,  Styptics,  Astringents,  and 
Hot  and  Cold  Applications. 


HAEMORRHOIDS. 

EXTERNAL  HEMORRHOIDS. 

Treatment  is  seldom  sought  unless  there  is  external 
inflammation. 

Hot  Baths,  frequent  ablution  of  the  part  with  Cas- 
tile soap  and  water,  together  with  rest  in  bed  and 
the  application  of  the  Ice  Bag,  will  prove  grateful 
and  effectual  in  most  cases. 

Hot  Fomentations  vasiy  be  used  instead  of  the  ice 
bag  if  the  latter  is  not  agreeable. 

Bathing  the  part  should  precede  all  remedial  appli- 
cations. 

The  following  anodyne  ointments  and  lotions  will 
afford  relief: 

Ext.  Belladonna  and  Ext.  Opium: — The  two  ex- 
tracts together  or  alone  smeared  over  the  part  will 
afford  relief.     (All.) 

Lead  and  Opium  Wash: — Constantly  applied  hot 
or  cold  is  verj^  effective.     (Gt.) 

Stramonium  Ointment : — Alone  or  with  equal  parts 
of  Gallic  Acid  Ointment,  is  one  of  the  most  service- 
able remedies .     ( Al . ) 

Hamamelis: — The  aqueous  extract  often  used  hot 
or  cold  according  to  the  effect  on  the  patient.  A 
little  may  be  injected  into  the  rectum. 


HEMORRHOIDS.  319 

After  washing  the  parts,   Mr.  AlHngham  recom- 
mends one  of  the  following : 


^. 

Bismuth.  Subnitratis, 

3ij- 

Hydrarg.  Chloridi  Mitis, 

3J. 

Cocainse, 

gr.  iv. 

Vaselini, 

u 

M. 

Or, 

^. 

Bismuth.  Subnitratis, 

3ij- 

Cocainse, 

gr-  vij. 

Vaselini, 

U 

M. 

Or, 

• 

?fc. 

Liq.  Pkmibi  Subacetat.  Dil., 

Sj. 

Liq.  Opii  Ext., 

3iv. 

Tr.  Belladonnae, 

3ij- 

M. 

When  the  piles  are  down  and  difficult  to  replace  or 
retain,  Mr.  Allingham  recommends  the  following  ap- 
plications spread  on  lint : 

^.    Ung.  Elemi,  Jss. 

Ung.  Sambuci,  Jss. 

Bal.  Copaibse,  ^j. 

Ext.  Belladonnae,  gss. 
M. 

Or, 

9*.    Ext.  BelladonnEe,  3j. 

Ext.  Hyoscyami,  gij. 

Ext.  Conii,  gij. 

Vaselini,  ^j. 
M. 

Nutgalls: — The  ointment  alone  or  with  1  drachm 
of  powdered  opium  to  the  ounce.     (Sm.) 
Nitrate  of  Silver: — Painting  the  piles  daily  with  a 


320         DIGEST  OF   EXTERNAL  THERAPEUTICS. 

2  per  cent,  solution  is  said  to  act  very  satisfactorily ; 
the  application  is  painless.     (T.,  98.) 

Iodoform: — Suppositories  containing  5  grains  each 
will  sometimes  have  good  effect.     (Sm.) 

The  following  is  recommended:  Wash  the  part 
w^ith  a  2  per  cent,  solution  of  carbolic  acid  or  1  per 
cent,  of  creolin,  dry  with  absorbent  cotton  and 
anoint  w^ith  the  following : 


^.    Chrysarobini, 
lodoformi, 

gr.  xij. 
gr.  ivss. 

Ext.  Belladonnse, 

gr.  ix. 

Vaselini, 
M. 

Svjgr.  XV. 

(Sn.) 

The  pain  will  be  relieved  and  the  tumor  will  almost 

completely  shrivel  within  three  or  four  months. 

The  following  also  proves  useful : 

^.    Cocain.  Muriatis, 

gr.  XX. 

Morph.  Sulphatis, 
Atrop.  Sulphatis, 
Pulv.  Acid.  Tannici, 

gr.  V. 
gr.  iv. 
gr.  XX. 

Vaselini, 

IJ. 

Ol.  Rosae, 
M. 

q.  s. 

Sig.     Apply  after  each  evacuation  of  bowels.              (Sn. ) 

Or, 

5fc.    Acid.  Gallici, 

gr.  x. 

Ext.  Opii, 

Ext.  Belladonnae, 

aa  gr.  iv. 

Ung.  Simplicis, 
M. 

Iss. 

Sig.     Apply  night  and  morning. 

(H.) 

The  following  is  indicated  when  the 

pile  contains  a 

hard  clot : 

^.    Morph.  Sulphatis, 

Hydrarg.  Chloridi  Mitis, 
Vaselini, 

M. 

gr.  iij. 
gr.  xij. 

(Gt.) 

HEMORRHOIDS.  321 

The  following  is  a  useful  cerate : 

Morphia  Oleate  (lo  per  cent.),  i  part. 

Camphor,  2  parts. 

Oil  of  Sassafras,  4  parts. 

Resin,  8  parts. 

Yellow  Wax,  16  parts. 

Benzoated  Lard,  24  parts. 

Apply  on  lint;  melt  the  wax,  resin,  and  lard  together  at  a  gentle 
heat,  then  digest  the  camphor  with  the  mixture  until  it  is  dis- 
solved, allow  it  to  cool,  and  before  it  solidifies  add  the  morphine 
and  sassafras,  and  mix  thoroughly.     (H.  F. ) 

Collodion  : — Applied  on  fibres  of  cotton  and  spread 
over  the  pile  after  defecation.     (T.,  98.) 

iEsculus  Hippocastanum: — Cerates  or  supposito- 
ries will  often  give  good  resalts.     (Bt.) 

Collinsonia: — The  cerate,  especially  when  asso- 
ciated with  uterine  disorder.     (Ga.) 

Boric  Acid: — An  ointment  with  vaseline  has  good 
effect  in  relieving  the  itching.     (Ga.) 

After  inflammation  has  subsided  the  haemorrhoids 
should  be  removed. 


INTERNAL  HEMORRHOIDS. 

Hamametis: — Employed  satisfactorily  in  various 
ways,  viz.:  Small  injections  of  the  watery  extract, 
either  hot  or  cold ;  compresses,  wet  with  the  lotion, 
applied  externallv,  or  ointments  or  suppositories. 
(All.) 

Cold: — Some  patients  will  derive  benefit  from  the 
application  of  ice  to  the  inflamed  part ;  small  injec- 
tions of  cold  water  will  also  be  found  suited  to  some 
cases.     (K.) 

Heat: — May  be  used  instead  of  cold  in  the  same 

22 


322  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

manner,  hot  fomentations  and  hot  sitz  baths  espe- 
cially is  there  is  strangulation  of  the  pile.     (F.) 
Suppositories  of  the  following : 

^.    Chrysarobini,  gr.  i^. 

lodoformi,  gr.  j\. 

Ext.  Belladounse,  gr.  I. 

Ol.  Theobromae,  gr.  xxx. 

(Sn.) 

If  there  is  severe  haemorrhage,  tannin  may  be  ad- 
ded. It  is  claimed  that  under  the  above  treatment, 
which  may  be  combined  with  the  ointment  of  the 
same,  w^hen  there  are  external  haemorrhoids  that 
pain  and  haemorrhage  will  disappear  within  three  or 
four  days  and  the  tumors  shrivel  completely  within 
three  or  four  months. 

The  following  is  a  useful  soothing  application : 

9=.    Cocain.  Hydrochloratis,  gr.  vij. 

Aq.  Ext.  Opii,  gr.  xx. 

Ext.  Belladonnae,  gr.  xij. 

Ung.  Populi,  Ij. 
M.  (Sj.) 

Cutol : — 10  per  cent,  ointment.     (Sj.) 

Hydrastis: — An  important  remedy  used  in  the  form 
of  suppositories;  it  may  be  combined  with  good 
eifect,  each  suppository  to  contain  the  following : 

1^.    Hydrastis, 

Hama.nelidis,  aa  gr.  iij. 

Cocain.  Hyrochloratis,  gr.  ^. 

Ol.  Theobromae,  q.  s. 

M.  (M.  H.) 

Stramonium  : — The  ointment  has  a  soothing  effect 
and  mav  be  combined  w^ith  cocaine  and  hamamelis. 
(All.) 


HEMORRHOIDS.  323 

A  sedative  ointment,  recommended  by  Shoemaker, 
is  as  follows : 

9:.    Ext.  Opii.  gr.  x. 

Pulv.  Stramonii,  .  3j- 

Pulv.  Tabaci,  ^ss. 

Ung.  Simplicis,  gss. 

M.  (Sn.) 

Zinc  Subgallate  : — As  an  antiseptic  and  dessicant, 
pure  or  diluted  with  an  inert  pow^der,  or  in  the  form 
of  an  ointment.     (F.) 

Ferric  Sulphate: — In  the  form  of  supositories,  2 
grains  each,  when  a  strong  astringent  effect  is  de- 
sired. (F.)  For  small  vascular  tumors  Mr.  Ailing- 
ham  uses : 

^.    Ferri  Sulphatis,  gr.  x-xx. 

Cocainae,  gr.  viij. 

Vaselini,  5j- 
M. 

Or, 

p.    Ferri  Sulphatis,  gr.  ij. 

Theobromae,  q.  s. 

M. 

Tannic  Acid: — In  various  strengths  in  ointments 
and  suppositories,  may  be  employed  w^hen  there  is 
much  inflammation.     (F.) 

Conium  Ointment : — May  be  applied  with  benefit 
for  the  relief  of  pain.     (M.  W.) 

Carbolic  Acid  Injections: — The  treatment  of  haem- 
orrhoids by  injections  of  carbolic  acid,  which  was 
apparently  so  successful  in  the  hands  of  certain  itin- 
erants, was  made  known  to  the  profession  in  1876 
by  Andrews  of  Chicago.  It  w^as  soon  extensively 
adopted,  but  experience  having  shoA?vn  that  not  in- 


324  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

frequently  it  was  folloA?\red  by  various  complications 
and  occasionally  by  death  (13  cases  out  of  3304), 
the  operation  has  fallen  into  disfavor. 

Recent  observers,  while  condemning  the  method  for 
general  use,  admit  is  applicability  to  certain  selected 
cases.  Some  operators  while  agreeing  with  this  view 
at  the  same  time  express  a  preference  for  the  clamp 
and  cautery. 

The  disinclination  or  the  impossibilltj^  of  the  pa- 
tient being  confined  to  bed  for  a  few  days  is  often  an 
important  factor  in  the  selection  of  the  injection 
treatment  which,  if  all  goes  w^ell,  does  not  require 
more  than  a  fev^  hours  in  the  recumbant  posture. 

If  treatment  by  injection  is  decided  upon,  the  prog- 
nosis should  alv^ays  be  guarded  as  to  pain,  the  time 
required  to  complete  treatment,  and  the  permanency 
of  results.  The  relief  obtained,  according  to  Kelsey, 
does  not,  as  a  rule,  last  for  more  than  two  years. 

If  it  is  decided  to  operate  according  to  this  method 
it  should  be  remembered  that  the  class  of  cases  are 
limited  to  those  in  which  the  haemorrhoid  is  small, 
distinct,  pendulous,  and  situated  above  the  grasp  of 
the  sphincter  muscle.  When  the  haemorrhoid  is  in- 
flamed, strangulated,  ulcerated,  external,  large, 
hypertrophied,  or  within  the  grasp  of  the  sphincter, 
the  injections  should  never  be  made.  Great  care  is 
necessary  in  the  selection  of  cases  lest  serious  and 
tedious  complications  arise. 

The  patient  should  be  prepared  for  the  operation 
by  administering  a  mild  cathartic  the  day  previous, 
and  about  two  hours  before  operating  an  enema 
of  Castile  soap  and  water  should  be  given  and  the 
bowel  emptied.  A  convenient  position  and  light 
should  be  selected,  and  the  anus  and  surrounding 


HEMORRHOIDS.  325 

parts  cleansed.  The  amount  injected  should  be  care- 
full}^  gauged  and  care  observed  not  to  allow  any  air 
to  enter.  The  injection  should  be  made  slowly  and 
into  the  centre  of  the  tumor,  some  say  into  the  most 
pendulous  portion. 

Although  other  agents  have  been  employed,  car- 
bolic acid  has  proved  itself  superior  and  should 
always  be  preferred.  The  strength  of  the  solution 
varies  all  the  way  from  3  to  50  per  cent.,  and  occa- 
sionally it  has  been  injected  undiluted.  The  weaker 
solutions  are  generally  recommended.  A  much  used 
preparation  is  1  part  of  the  acid  w^ith  2  parts  of 
olive  oil.  Sometimes  a  weak  solution  will  cause 
sloughing  when  a  stronger  will  not.  The  follow^ing 
are  some  of  the  more  complex  formula  for  injecting 
fluids : 

?fc.    Acid.  CarboHci,  SJ- 

Zinc.  Chloridi,  gr.  viij. 

01.  Olivae,  |v. 

M.  (Ad.) 

This  is  said  to  be  the  secret  remedy  known  as  the 
"Brinckerhoff"Cure." 

Another  injection  of  the  secret  remedy  class  is  as 
follows : 

9:.    Acid.  CarboHci, 

Glycerini,  aa  5ij- 

Fid.  Ex.  Ergotae,  3j. 

Aquse,  3ij. 

M.  (Ad.) 

In  small  haemorrhoids  inject  from  2  to  4  drops  in 
large  from  5  to  10  drops;  inject  only  one  or  tw^o 
haemorrhoids  at  a  time  and  allow  ten  days  to  inter- 
vene between  operations.  Let  the  needle  remain 
in  position  until    the  part  becomes  white.     Avoid 


326  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

injecting  the  tissues  beneath  the  tumor  or  wound- 
ing the  rectum.  As  the  needle  is  withdrawn  ap- 
ply the  finger,  in  order  to  arrest  haemorrhage  and 
to  prevent  the  escape  of  the  fluid.  All  prolapsed 
haemorrhoids  should  be  returned  and  the  external 
parts  anointed  with  vaseline  to  prevent  irritation 
from  oozing  of  the  injecting  fluid.  After  treatment 
the  patient  should  remain  in  the  recumbent  posture 
for  half  an  hour,  and  for  the  next  few  days  his  diet 
should  be  restricted  to  semi-solid  food. 

The  fluid  should  be  made  fresh  for  each  injection 
and  the  sj'ringe  carefully  sterilized. 

For  the  methods  of  removal  of  haemorrhoids  the 
reader  is  referred  to  w^orks  on  surgery. 


HAY  FEVER. 

Compare  Acute  Rhinits. 

Cocaine  Hydrochlorate : — One  of  the  best  pallia- 
tives for  treatment  of  the  exacerbations ;  may  be  ap- 
plied in  the  form  of  a  spray,  by  insufflation,  or  with 
a  brush ;  occasionally  the  relief  obtained  will  last  for 
the  day,  but  more  frequently  it  is  transitory.  For 
the  spray  a  simple  4  per  cent,  solution  may  be  em- 
ployed, v^hich  is  the  usual  strength,  but  not  infre- 
quently w^eaker  solutions  w411  act  quite  as  well. 

The  following  are  recommended  by  Bos  worth : 


Cocain.  Hydrochloratis, 

gr.  x: 

Sodii  Bicarbonatis, 

Acid.  Bond, 

aa  gr.  x, 

Aq.  Destill., 

n 

HAY   FEVER. 

|k.    Cocain.  Hydrochloratis, 

gr.  X, 

Aquae, 

q.  s. 

Ft.  sol.  et  adde 

* 

Fid.  Cosmolini, 

n 

M. 

Sig.     Shake  well  before  using. 

327 


Insufflations  of  cocaine  may  be  used  according  to 
the  following : 

9r.    Cocain.  Hydrochloratis,  gr.  x. 

Bismuth.  Subcarbonatis,  3J. 

Magnesise  Carb.  Levis,  gij. 
M. 

Or, 

9'.    Morph.  Tartratis,  gr.  j. 

Cocain.  Hydrochloratis,  gr.  x. 

SulphurisFlor.,  5ss. 

Sac.  Lactis,  3"ss. 
M.  (Bos.) 

Suprarenal  Extract  : — Ingals  and  Ohls  state  that 
they  have  obtained  much  relief  in  hay  fever  by  the 
use  of  an  extract  of  suprarenal  capsule  prepared  as 
follows : 

Adrenals,  i  drachm. 

Boric  Acid,  i6  grains. 

Cinnamon  Water,  4  drachms. 

Camphor  Water  (hot),  i  ounce. 

Distilled  Water  (hot)  to  make  2  ounces. 

Macerate  for  four  hours,  then  filter. 
Use  as  a  spray  to  the  nose  four  or  five  times  a  day.     This  solution 
remains  stable  for  several  weeks.     (A.  M.  S.,  99.) 

Good  results  may  also  be  obtained  from  the  appli- 
cation of  an  aqueous  solution,  which  acts  as  a 
pow^erful  vaso-constrictor  and  contractor  of  erectile 
tissue. 


328  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Menthol: — Preferred  to  cocaine  by  Ball;  5  to  10 
per  cent,  solutions  in  albolene  or  some  other  of  the 
petroleum  derivatives  are  employed  with  the  atom- 
izer. 

The  same  writer  recommends  the  following : 

Rectified  Spirits,  with  2  or  3  parts  of  water. 

Chromic  Acid,  gr.  ^^-^^. 

Quinine  Sulphate,  gr.  ij— xi— §ij. 

Sulphurous  Acid  and  water,  equal  parts. 

Carbolic  Acid,  1  part  to  60. 

The  following  was  advised  by  Sir  Andrew  Clark : 

9;.    Glyceriti  Acid.  Carbolici,  ^j. 

Quininse  Hydrochloratis,  3J. 

Hydrarg.  Bichlorid.,  gr.  |. 

M. 

Sig.  Paint  on  the  floor  of  the  nose  to  naso-pharynx;  two  or 
three  applications  will  sometimes  suffice  to  cure  a  parox- 
ysm for  the  season,  but  the  immediate  effects  are  ex- 
ceedingly irritating.     ( Ba. ) 

Acetic  Acid : — 2  per  cent,  solutions  as  nasal 
washes.    (T.,  98.) 

Boric  Acid  and  Salicylic  Acid: — Equal  parts  as  an 
insufflating  powder.     (Al.) 

Sodium  Bisulphate: — Solutions  of  1-5000  in  water 
as  a  nasal  wash.     (T.,  98.) 


HEADACHE. 

When  congestive,  Hot  Foot  Baths,  Mustard  Foot 
Baths  or  Mustard  Plasters  to  the  back  of  the  neck 
are  of  service.     (Wa.) 

Cold  Water  Effusions  to  the  head  or  Ice  Bag  will 
sometimes  relieve  both  congestive  and  bilious  sick 


HEART   DISEASE,    CHRONIC.  329 

headache;   on  the  other  hand  Warm  Applications 
\vill  suit  some  cases  better.    (R.) 

Morphine: — A  hj'^podermic  injection  of  a  small  dose 
acts  frequently  with  excellent  effect  and  is  one  of  the 
most  reliable  remedies,  at  the  same  time  one  to  be 
avoided  until  other  means  have  been  tried.  (Ty.) 
The  liability  of  forming  the  drug  habit  must  be 
considered.  In  headaches,  or  neuralgia  occurring  fre- 
quently, if  opium  in  any  of  its  forms  is  used  this  un- 
fortunate result  is  like  to  occur. 


HEART  DISEASE,  CHRONIC. 

The  Schott  Treatment : — This  consists  of  exercises 
and  carbonated  brine  baths,  and  is  practiced  with 
beneficial  results  at  Nauheim,  Germany.  By  the  use 
of  artificial  baths  the  treatment  can  be  carried  out 
at  home.  The  follow^ing  is  an  outline  of  the  home 
treatment : 

Synopsis  of  exercises. 

1.  Movement  of  extended  arms  in  three  directions. 

(a)  From  ordinary  position  by  the  sides  of  the 
body  forward  and  upv^ard  until  they  reach  the  tem- 
ples and  back  again. 

(b)  From  the  same  position,  laterally  outward 
and  upward  to  the  temples  and  back  again. 

(c)  From  the  horizontal  position  with  the  palms  of 
the  hands  meeting  in  front  of  the  body  as  far  apart 
as  possible  and  back.  Rotation  of  the  extended  arms 
about  their  axes  as  fiilly  as  possible,  causing  prona- 
tion and  supination. 

2.  For  the  elbow,  wrist  and  finger  joints  the  nat- 


330  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

ural  flexions  and  extensions ;  radial  and  ulnar  abduc- 
tion and  adduction. 

3.  (a)  Flexion  of  trunk  forward  from  a  little  be- 
yond the  erect  position  and  back. 

(b)  Lateral  flexions  of  the  trunk  to  the  right,  left 
and  back. 

(c)  Rotation  of  the  trunk  on  its  axis  to  right,  left 
and  back. 

4.  Movements  of  each  extended  leg  forward,  up- 
ward, outward,  upward,  backward,  upward  and 
back. 

5.  The  natural  flexions  and  extensions  of  the  knee 
and  ankle  joints. 

Resistance  is  made  by  the  attendant  with  the  palm 
of  the  hand  in  the  direction  exactly  opposite  to  the 
movement.  In  applying  it  to  the  wrist  or  ankles 
these  parts  should  be  placed  in  the  fork  formed  by 
separating  the  thumb  and  index  finger;  the  limb 
should  never  be  grasped  lest  support  be  given.  The 
degree  of  resisting  force  should  be  as  much  as  the 
patient  can  overcome  without  the  slightest  discom- 
fort, and  should  be  applied  uniformly  and  evenly. 
The  patient  must  be  able  to  breathe  quietly;  the 
mouth  and  alae  nasi  must  be  watched,  and  on  the 
slightest  indication  of  shortness  of  breath  there 
should  be  a  pause.  Some  of  the  movements  maj^  be 
omitted,  according  to  circumstances ;  the  arms  above 
the  head  and  the  trunk  exercises  are  the  most  trying. 
The  limbs  must  not  be  allowed  to  fall  suddenly  after 
the  completion  of  a  movement.  The  clothing  should 
be  loose  and  easy,  and  a  considerable  interval  of  time 
be  allow^ed  between  the  movements.  This  should  be 
prolonged  if  there  is  fatigue. 

The  exercises  are  usually  given  for  about  half  an 


HEART  DISEASE,   CHRONIC.  331 

hour,  the  series  being  gone  over  twace  in  that  time, 
but  they  are  frequently  employed  for  a  shorter  or 
longer  period.  A  skilled  attendant  is  necessary. 
(Thn.) 

Tw^o  new  exercises,  not  resisted  by  the  operator, 
have  recently  been  suggested  by  Dr.  T.  E.  Satter- 
thwaite,  assisted  by  Dr.  H.  V.  Barclay,  which  are 
described  as  follows : 

The  patient  lying  on  his  back  with  the  head  a  little 
elevated,  the  operator  standing  at,  his  side  passes  his 
two  arms  under  the  chest  and  then  raises  it  slowly 
and  gently  as  far  as  possible  without  lifting  the 
patient  off  his  bed.  Then  the  chest  is  allowed  to  set- 
tle back  into  its  normal  position.  This  movement 
is  of  the  nature  of  artificial  respiration,  and  is  useful 
in  the  cardiac  degeneration  of  obese  persons  and  in 
some  cardiac  cases,  with  respiratory  embarrassment 
owing  to  chronic  pulmonary  disease.  In  some  rare 
cases  of  chronic  pulmonary  disease  with  a  cardiac 
complication  great  relief  and  benefit  might  be  ob- 
tained without  danger,  if  such  respiratory  exercises 
are  judiciously  applied. 

Another  of  these  respiratory  series  consists  in  ele- 
vation of  the  shoulders.  The  patient  sitting  on  a 
stool,  the  operator  on  another  stool  behind  him 
grasps  the  axillje  of  the  patient  in  front,  he  now  lifts 
the  patient's  body  upwards  as  far  as  it  would  go 
v^ithout  leaving  the  stool,  and  then  draws  the  body 
over  backwards,  pressing  his  knee  against  thehollov^r 
of  the  patient's  back.  The  body  was  then  allowed 
to  settle  down  easilv  into  the  original  position.  (M. 
T.,  4,  98.) 

Artificial  Nauheim  Baths: — A  scheme  for  a  six 
weeks'  course  of  baths  would  be  about  as  follows : 


332  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

First  Week. — ^/^  per  cent,  warm  sea  salt  bath  (2  lbs. 
to  50  gals.).  Temperature  94  to  95  degrees  F.  Dura- 
tion four  minutes.     Intermission  on  third  da3^ 

Second  Week. — %  per  cent,  warm  salt  bath  (3  lbs. 
to  50  gals.).  Temperature  93  to  94  degrees  F.,  six 
minutes.  Intermission  on  fourth  da3^;  V4,  per  cent, 
carbonic  acid  gas. 

Third  Week. — 1  per  cent,  warm  rock  salt  bath  (4 
lbs.  to  50  gals.).  Temperature  92  to  93  degrees  F. 
'  Carbonic  acid  gas,  V^  per  cent.,  eight  minutes.  Inter- 
mission every  fourth  day. 

Fourth  Week. — l^A  per  cent,  bath  salt,  warm  (5 
lbs.  to  50  gals.).  Temperature  91  to  92  degrees  F. 
Nauheim  concentrated  brine  salts,  8  ounces,  ten  min- 
utes. Carbonic  acid  gas,  %  per  cent.  Intermission 
fourth  day. 

Fifth  Week.— 11/2  per  cent,  bath  salts  (7  lbs.  to  50 
gals.).  Temperature  90  to  91  degrees  F.  Nauheim 
concentrated  salts,  10  ounces,  twelve  minutes.  Car- 
bonic acid  gas,  %  per  cent.     Intermission  fifth  day. 

Sixth  Week.— 2  per  cent,  bath  salt  (10  lbs.  to  50 
gals.).  Temperature  80  to  88  degrees  F.  Nauheim 
concentrated  salts,  12  ounces,  and  carbonic  acid  gas. 
1  per  cent.,  fourteen  minutes.  Intermission  every 
fifth  day.     . 

It  is  stated  in  conclusion  that  the  patient  does  not 
always  feel  better  after  a  bath.  There  may  be  some 
praecordial  oppression,  but  this  discomfort  usually 
passed  a-way  at  the  end  of  a  w^eek. 

Baths  and  exercises  each  accomplish  the  same  re- 
sult, but  the  most  rapid  and  brilliant  results  are 
obtained  when  both  are  used  together.  They  are, 
however,  useful  only  up  to  a  certain  point ;  after  this 
has  been  reached  they  are  harmful,  and  if  at  any  time 


HEART  DISEASE,   CHRONIC.  333 

there  is  a  tendency-  to  relapse,  the  baths  should  be 
suspended,  generally,  however,  to  be  resumed  again 
after  a  day  or  two.  The  final  step  in  the  treatment 
is  tw^o  or  three  weeks  of  rest  at  some  place  of  mod- 
erate elevation.  In  successful  cases  the  improvement 
is  gradual  and  sometimes  does  not  fully  show  itself 
until  the  patient  had  resumed  his  ordinary  mode  of 
life.  The  improvement  may  continue  for  many 
months,  in  some  cases  for  more  than  a  year.  (M. 
T.,  4,  98.) 

The  contra-indication  in  the  entire  range  of  chronic 
cardio-vascular  affections  are  advanced  arterio-scler- 
osis,  decided  degeneration  of  the  cardiac  muscles  and 
aneurism.     (T.,  98.) 

Carbonic  Acid  Gas  Inhalations: — Favorable  re- 
ports have  recently  been  published  in  regard  to  the 
value  of  carbonic  acid  gas  in  the  treatment  of  valvu- 
lar diseases  of  the  heart.  Dr.  Ewart,  of  London, 
observing  that  inhalations  of  carbonic  acid  gas  in  a 
disguised  form  constitutes  part  of  the  Nauheim 
treatment,  has  employed  these  inhalations  as  a  dis- 
tinctive therapeutic  measure.  In  using  the  gas  three 
essentials  are  necessary:  A  continuous  spray  abso- 
lutely free  from  all  traces  of  the  dangerous  mon- 
oxide ;  sufficient  means  for  controlling  the  delivery 
and  insuring  a  simultaneous  inhalation  of  air;  a 
convenient  length  of  rubber  tubing  provided  with  a 
mouth  piece.  The  apparatus  employed  is  described 
as  follows :  It  consists  of  three  bottles  in  a  box,  a 
small  narrow  wash  bottle  and  two  larger  bottles, 
each  with  small  necks  at  the  bottom ;  these  two  in- 
ferior necks  are  connected  with  rubber  tubing  con- 
trolled by  a  clip,  through  which  hydrochloric  acid 
travels  from  one  bottle  to  the  other.    The  hydro- 


334  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

chloric  acid  supply  bottle  must  be  raised  and  left 
open  while  in  use.  The  top  of  the  other  bottle  is 
connected  by  a  rubber  tube  with  the  wash  bottle, 
which  contains  a  layer  of  glass  marbles  and,  above 
this  a  layer  of  chipped  marble  which  is  left  high  and 
dry  on  the  glass  bed.  When  the  carbonic  gas  press- 
ure is  sufficientl3^  raised  in  the  bottle  by  shutting  off 
the  tube,  all  the  hydrochloric  acid  is  driven  back  and 
saved  by  closing  the  clip  and  putting  a  stopper  in 
the  bottle.  The  inhalation  is  made  by  holding  the 
mouth-piece  between  the  teeth  while  the  lips  remain 
open.  This  insures  the  entrance  of  air.  The  effects 
in  the  healthy  are  as  follows :  A  feeling  of  internal 
w^armth;  a  strong  desire  to  breathe,  and  particu- 
larly to  breathe  out ;  an  excited  state  of  the  circula- 
tion; a  slight  giddiness  and  even  headache.  The 
effects  in  patients  with  cardiac  symptoms,  according 
to  Ew^art,  have  been  as  follows :  Rapid  diminution, 
and  w^ithin  a  minute  or  two  cessation  of  cardiac  dis- 
tress or  pain ;  a  feeling  of  increasing  freedom  of  respi- 
ration ;  a  visible  increase  in  the  depth  of  breathing ; 
a  marked  improvement  in  the  pulse ;  an  obvious  im- 
provement both  in  the  expression  and  in  the  com- 
plexion. 

It  is  claimed  that  systematic  repetition  of  the  inha- 
lations bring  about  progressive  improvement  in  the 
patient's  general  condition.  As  regard  to  the  appli- 
cation of  the  treatment,  it  was  found  that  loss  of 
compensation  in  any  valvular  disease  admits  of  ten- 
tative treatment  by  carbonic  acid  gas,  and  will  re- 
spond to  it  in  varying  degrees.  True  angina,  which 
forbids  the  use  of  Nauheim  baths,  may  be  safely 
treated  w^ith  the  inhalation;  and  in  the  minor  de- 
grees of  angina  it  has  never  failed  to  give  relief.    In 


HERNIA,    STRANGULATED,  335 

the  worst  cases  of  mitral  and  aortic  stenosis,  aortic 
regurgitation,  and  mitral  disease  with  angina  and  in 
mitral  stenosis  with  pulmonary  congestion,  relief 
was  very  marked.  In  the  cases  reported  inhalations 
were  administered  several  times  a  day. 

The  rate  of  the  gas  escape  may  be  judged  from  the 
rapidity  of  the  bubbling,  which  can  be  easily  adapted 
to  the  requirements  of  each  case  by  altering  the  aper- 
ture of  the  pressure  key.  For  average  inhalations 
the  bubbles  should  be  allow^ed  to  pass  as  fast  as  they 
can  be  counted.  When  this  rate  is  not  exceeded  no 
possible  danger  can  arise,  even  when  the  inhalations 
are  continued  for  some  time.  (B.  M.  J.,  10,  28,  99.) 


HEMIPLEGIA. 

See  Paralysis. 

HERNIA,  STRANGULATED. 

The  patient  should  be  placed  on  his  back  in  bed, 
the  foot  of  w^hich  should  be  elevated  about  twelve 
inches,  the  pelvis  raised  upon  a  pillow,  the  legs  flexed 
upon  the  thighs,  and  thighs  upon  the  abdomen,  or 
the  knee  and  shoulder  position  may  be  assumed. 
(W.) 

Hot  Applications: — Hot  baths  should  be  tried  or 
towels  dipped  in  hot  water  partly  wrung  out  and 
laid  on  the  part,  and  constantly  renew^ed,  v^ill  some- 
times assist  in  relieving.     (W.) 

Ice  : — A  bag  filled  with  ice  is  also  employed  w^ith 
effect.     (F.) 


336  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Opium: — Opium  narcosis  should  be  secured  at  once 
to  relieve  the  pain  and  relax  the  parts.  Morphia, 
subcutaneously,  or  opium  suppositories  maj^  be  ad- 
ministered.    (W.) 

Ammonium  Chloride: — In  the  absence  of  ice  dis- 
solve 5  parts  of  the  ammonia  with  5  parts  of  nitrate 
of  potash  in  16  parts  of  w^ater;  the  temperature  of 
the  combined  solution  wnll  fall  from  50°  to  10°  F. 
This  is  placed  in  a  bladder  and  applied  to  hernial 
tumors  to  promote  reduction.     (Al.) 

Chloroform  Inhalation: — To  assist  in  reduction  has 
superseded  the  use  of  tobacco  and  lobelia.     (P.) 

Lobelia: — The  infusion  may  be  given  by  enema 
with  good  effect.     (F.) 

Tobacco: — Enema  of  the  smoke,  or  one  containing 
not  more  than  15  grains,  has  proved  of  great  value, 
but  lobelia  is  generally  to  be  preferred.     (F.) 

Taxis: — If  applications  do  not  succeed  in  an  hour 
or  two  reduction  should  be  attempted.  All  efforts  in 
that  direction  should  be  gentle;  a  trial  should  first 
be  made  without  anaesthesia,  then,  if  unsuccessful, 
w^ith  an  anaesthetic.  (Ger.)  The  neck  of  the  tumor 
should  be  grasped  between  the  thumb  and  finger  of 
one  hand  and  the  contents  gentl}^  pushed  into  the 
canal  with  the  other.  Taxis  should  not  be  continued 
more  than  five  or  ten  minutes  at  a  time ;  it  may  be 
repeated  at  intervals  of  half  an  hour  during  the  first 
six  hours  of  the  strangulation ;  after  that  it  is  of 
doubtful  utility,  if  not  harmful,  and  after  twelve 
hours  should  not  he  attempted.     ( W.) 

Operation: — When  strangulation  is  not  reduced 
herniotomy  should  be  performed  within  six  hours 
after  the  accident,  and  should  never  be  dela3^ed  more 
than  twelve  hours.    Better  results,  says  Wyeth,  are 


HERPES   PROGENITALIS.  337 

obtained  if  the  operation  is  performed  during  the 
earher  period. 


HERPES  CIRCINATUS. 

See  Trichophytosis  Corporis. 

HERPES  LABIALIS. 

See  Herpes   Simplex. 

HERPES  PROGENITALIS. 

UsualW  httle  treatment  will  be  required.  Cleanse 
the  parts,  apph'  an  antiseptic  lotion,  then  dry  and 
dust  on  a  mild  powder,  such  as  equal  parts  of  Bis- 
muth Subnitrate  and  Zinc  Oleate  (CI.),  or  apply  a 
piece  of  lint  soaked  in  Lead  W^ater  or  Black  W^ash. 
<Vn.) 

Calomel: — Pure  or  with  equal  parts  of  Zinc  Oxide 
sprinkled  on  night  and  morning  is  useful  when  stimu- 
lation is  required.     (Vn.) 

Aristol  or  Airol: — Usefiil  for  abrasions. 

A  solution  of  Menthol  in  alcohol  1  per  cent,  or  a 
25  per  cent,  aqueous  solution  of  Carbolic  Acid  ap- 
plied at  the  first  indication  of  the  formation  of  vesi- 
cles will  frequently  act  as  preventives.     (Cltn.) 

Cold  Douches  to  the  lumbar  region  for  half  a 
minute  twice  a  week,  extra  cleanliness,  and  the  ap- 
23 


338  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

plication  of  a  little  Alcohol  as  soon  as  eruption 
seems  about  to  appear  are  also  effective  preventive 
measures.  Astringent  lotions  are  indicated  if  there 
is  a  tendenc}^  to  recurrence.     (CI.) 


HERPES  SIMPLEX. 

Treatment  is  very  simple,  consisting  of  soothing 
and  emollient  applications  ;  if  on  the  lip  a  little  Cold 
Cream  or  Oleate  of  Bismuth  Ointment  (see  McCall 
Anderson's  ointment  under  Acute  Eczema).  Care 
should  be  observed  not  to  detach  the  crusts  too 
soon. 

In  extensive  cases  of  herpes  of  the  face  apply  Bread 
and  Milk  Poultice,  Dilute  Lead  Water  or  Boric 
Acid  in  the  po\srder,  and  when  there  are  crusts  some 
mild  ointment.     (Vn.) 

Camphor: — Will  often  abort  the  vesicles,  and  may 
be  applied  in  the  form  of  spirits  or  equal  parts  of  the 
powder  wath  borax.     (B.  H.) 

Flexible  Collodion: — Very  useful,  especially  for  the 
lips.     (F.) 

Ichthyol : — 1  per  cent,  solution,  or  an  ointment  of 
Zinc  Ichthyolate,  1  per  cent.     (B.  H.) 

The  follov«^ing  antiseptic  and  astringent  lotions  are 
recommended : 

Resorcin,  2  per  cent.;  Thymol,  3  per  cent.;  Men- 
thol, 2  per  cent.;  Tannin,  2  per  cent.,  applied  fre- 
quently. 


HERPES  ZOSTER.  339 


HERPES  ZOSTER. 

It  is  important  to  prevent  rupture  of  the  vesicles, 
which  leads  to  ulceration.  To  attain  this  end  avoid 
ointments  and  apply  bland  astringent  powders,  such 
as  Bismuth,  Zinc  Oxide,  or  Starch,  or  paint  the  part 
with  Flexible  Collodion,  alone  or  combined  w^ith 
Morphine  (gr.  x— gj),  A  soft  linen  bandage  should 
complete  the  dressing.     ( Pp . ) 

A  useful  dusting  powder  is  as  follows : 

9:.    Morph.  Sulphatis,  gr.  ij. 

Pulv.  Amyli, 

Zinc.  Oxidi,  aa  gss. 

M.  (Vn.) 

Electricity  -. — The  constant  current,  according  to 
Duhring,  will  relieve  if  it  does  not  abort.  The  sponge 
electrode  is  placed  along  the  course  of  the  nerves, 
and  directly  to  the  seat  of  the  eruption ;  five  to  ten 
cells  maybe  used,  and  the  application  made  for  fifteen 
minutes  twice  daily. 

The  following  lotions  will  prove  useful:  Lead 
Water,  Lead  and  Opium  Wash,  Fid.  Ext.  Grindelia 
§ss-Oj,  or  Zinc  Carbonate  Precipitate,  with  Pow- 
dered Starch  and  Glycerine,  each  half  an  ounce  w^ith 
w^ater  half  a  pint.     (Vn.) 

The  following  forms  an  effective  lotion  for  the  relief 
of  pain;  it  should  be  applied  with  wadding  pads, 
frequently  renew^ed : 


T^.    Alcoholis, 

•SJ- 

Mentholi, 

gr.  XV. 

Ext.  Cannabis  Indicae, 

gr.  XXV. 

M. 

(T.,  98.) 

340  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Cerates  of  Calendula,  Camphor,  Veratrine,  half 
strength,  and  Zinc  Oxide  Ointment  are  indicated. 
(Bt.) 

Cerate  of  Cocaine: — May  be  used  with  some  cau- 
tion, according  to  the  extent  of  exposed  surface  in- 
volved.    (M.  W.) 

Ext.  Belladonna  or  Ext.  Opium: — An  ointment  of 
either,  in  the  strength  of  20  grains  to  the  ounce,  may 
be  rubbed  on  when  the  eruption  occurs  on  the  scalp. 
(Vn.) 


HICCOUGH. 

Whiskey,  Vinegar,  Hot  Brandy,  or  Mustard 
Plasters  over  the  epigastrium  frequently  act  very 
speedily.  Blisters  to  epigastrium.  Cold  Shower, 
for  the  physiological  effect  of  shock  on  the  pneumo- 
gastric  nerve.  Ice  or  Leeches  to  epigastrium,  espe- 
cially in  inflammatory  forms.  Hard  Pressure  over 
epigastrium,  a  firm  bandage  or  belt.     (Bt.) 

Deep  Inspirations  and  holding  the  breath  as  long 
as  possible  is  effective  in  mild  cases.     (Ta.) 

The  following  measures  have  been  reported  by 
Sajous  as  having  been  successfully  employed  in  obsti- 
nate cases : 

Dry  Cups  over  the  abdomen;  energetic  Pressure 
of  the  soft  part  of  the  patient's  thumb  against  the 
little  finger  of  the  same  hand ;  Morphia  and  Atropia, 
subcutaneously,  in  sufficient  doses  to  induce  sleep; 
pungent  snuff"  or  other  Sternutories  to  produce  hard 
sneezing  have  succeeded  after  failure  of  other  means ; 
Apomorphia,  subcutaneously,  to  produce  emesis  has 


HORDEOLUM.  341 

been  followed  by  relief;  Massage;  Nitrite  of  Amyl 
inhalations. 

Pilocarpine  : — Has  succeeded  when  all  other  reme- 
dies have  failed,  in  doses  of  y^^  grain  three  times  a 
day  subcutaneously.  It  appears  best  suited  to  cases 
of  nervous  origin.     (T.,  96.) 

Electricity : — The  various  forms  of  this  agent 
should  be  tried  in  intractable  cases.     (T.,  96.) 


HORDEOLUM. 

Warm  Fomentations  or  Hot  Stupes  afford  the 
most  relief  and  hasten  suppuration.     (N.  O.) 

Nitrate  of  Silver: — Applied  early  will  abort;  a  so- 
lution of  gr.  V-5J,  is  recommended  by  Bull,  and  one 
of  gr.  xx-xl-§j  by  Roosa. 

Hydrarg.  Oxidi  Flavi: — An  ointment  of  gr.  j— 5J 
rubbed  in  is  useful  in  the  beginning  of  the  affection. 
(Ro.) 

When  the  swelling  points  it  should  be  punctured 
■with  a  Baer  or  Graefe  knife.     (Nt  O.) 

Errors  of  refraction  should  be  investigated  as  they 
may  act  as  a  cause. 


HYDROCELE. 

Tr.  Iodine: — After  evacuating  the  sac,  inject  one- 
half  to  1  drachm  of  a  tincture  made  with  crystals  of 
iodine  1  part  to  19  parts  of  alcohol,  95  per  cent.,  this 
is  allowed  to  stand  uncorked  for  a  few  days.  In  in- 
fants a  weak  solution  of  iodine  or  collodion  applied 
externally  will  cause  the  hydrocele  to  disappear. 
(CI.) 


342    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Another  method  for  the  use  of  iodine  is  the  follow- 
ing: Puncture  the  sac  \^ith  a  trocar  and  allow- 
about  one- third  of  the  fluid  to  flow  away,  then  inject 
about  three-quarters  to  1  drachm  of  a  1  per  cent- 
solution  of  Cocaine  ;  after  an  interval  of  five  minutes 
the  fluid  is  drawn  off  and  tincture  of  iodine  pure  or 
mixed  with  one-third  water  is  injected,  and  the 
w^hole  evacuated  after  five  minutes.     (Sj.) 

Injection  of  iodine  causes  great  pain  and  swelling 
w^ith  refilling  of  the  sac,  which  will  require  rest  in 
bed  for  a  few  days  with  the  use  of  hot  fomentations 
and  anodynes,  but  the  results  are  generally  satis- 
factory. Contra-indications  to  its  administration 
are  the  presence  of  pus  or  blood  in  the  effusion,  and 
thickening  or  calcareous  degeneration  of  the  walls  of 
the  sac.     (CI.) 

Carbolic  Acid: — After  evacuation,  injection  of  30 
minims  of  the  liquified  acid  (carbolic  acid  8  parts, 
glycerine  1  part) ;  sloughing  never  occurs  unless  a 
greater  quantity  is  used.  This  procedure  is  compara- 
tively painless,  the  inflammatory  action  much  less 
than  with  iodine,  and  the  patient  is  not  forced  to 
rest  more  than  a  day,  sometimes  not  at  all.     (CI.) 

Injection  of  30  minims  of  a  freshly  prepared  solu- 
tion of  equal  parts  of  the  pure  acid  and  glycerine  are 
also  recommended.  (Sj.)  The  contra-indications  in 
the  use  of  carbolic  acid  injections  are  the  same  as 
those  for  iodine. 

Treatment  by  Open  Puncture : — The  sac  is  tapped 
in  the  usual  v^ray  with  a  trocar  and  canula,  but  the 
latter  is  left  in  situ  to  act  as  a  drain ;  a  light  cotton 
dressing  and  a  slightly  compressing  bandage  is  then 
applied.  A  fenestrated  drainage  tube  may  be  passed 
through  the  canula,  w^hich  is  then  removed  and  the 


HYPERTRICHOSIS.  343 

tube  left  in  its  place.  For  two  or  three  days  the  sac 
is  irrigated  with  a  mild  antiseptic  solution,  and  at 
the  end  of  three  days  the  tube  is  shortened  and 
finally  removed.     (T.,  96.) 

Another  method,  viz.:  Introduce  a  trocar  into  the 
lower  part  of  the  sac  and  evacuate  the  contents,  then 
wash  out  the  cavity  with  a  3  to  5  per  cent,  solution 
of  carbolic  acid.  The  trocar  is  now  pushed  through 
the  sac  wall  and  brought  out  at  its  upper  end,  a  fen- 
estrated drainage  tube  is  passed  through  the  canula 
and  the  exudations  thus  allowed  to  escape  without 
accumulating ;  antiseptic  dressing  should  be  applied 
and  the  tube  removed  on  the  eighth  day.  No  anaes- 
thesia is  said  to  be  necessary.  Cicatrization  requires 
from  eight  to  ten  days.     (T.,  96.) 

After  injecting  iodine  or  carbolic  acid  a  certain 
amount  of  manipulation  of  the  part  must  be  made  in 
order  to  bring  the  injected  fluid  in  more  intimate 
contact  with  the  tissues. 

Ammonium  Chloride: — Lint  saturated  in  solutions 
of  gr.  x-5J  and  kept  continuously  applied,  is  used 
with  advantage  in  congenital  hydrocele.     (Al.) 


HYPERHIDROSIS. 

See  Bromidrosis. 

HYPERTRICHOSIS. 

Electrolysis: — This  is  the  most  effective  and  suc- 
cessful method  of  treatment,  and  should  be  per- 
formed to  depilation.    Its  action  is  permanent. 


344  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

The  growth  of  the  neighboring  fine  hairs  appears 
to  be  stimulated  by  the  electricity,  hence  the  opera- 
tion must  be  repeated.  When  carefully  performed 
little  scarring  will  result.    (Vn.) 

Epilation: — This  consists  in  removing  the  hairs 
and  inserting  and  rotating  in  each  hair  follicle  a 
glover's  needle  which  has  been  dipped  in  carbolic 
acid.     (Kp.) 

Depilatory  Powders:  —  These  agents  commonly 
contain  Arsenic  Tersulphide,  Barium  Sulphide, 
Calciuni  Sulphide,  or  Quicklime.  They  are  not  to 
be  relied  upon,  being  temporary  in  effect.  They 
cause  moreover,  a  renewed  growth  of  coarser  hair, 
and  redden  and  inflame  the  skin.  When  for  any  rea- 
son they  may  be  required,  the  following  can  be  em- 
ployed : 

*'Rusma  of  the  Turks." — Orpiment  1  part,  quick- 
lime or  chalk  10  parts,  starch  10  parts.     (F.) 

Delacroix's  "  Poudre  Subtile^ — Orpiment  4  parts, 
quicklime  30  parts,  powdered  gum  60  parts.     (F.) 

Reviel's  Mixture : 

ifc.    Calcii  Sulphidi,  3  v. 

Ess.  Limonis,  gtt.  xx. 

Amyli  Glyceriti, 

Amyli,  aa  ^iiss. 

M. 

Duhring  recommends : 

Jfc.    Barii  Sulphidi,  ^ij. 

Amyli, 

Zinc.  Oxidi,  aa  ^iij. 

M. 

T^.    Sodii  Sulphidi,  ^ij. 

Cretae  Prseparatae,  .^vj. 

M.  (F.) 


HYSTERIA.  345 

The  following  is  said  to  be  in  vogue  in  Turkey : 

9;.    Arsenici  Trisulpliureti,  ^ij. 

Calcis  Vivi,  ^ij. 

Amyli,  .^^j^v. 

Aq.  Bullientis,  q.  s. 
M.  (Vn.) 

These  powders  are  made  into  a  paste  and  applied 
to  the  skin ;  as  soon  as  dry  they  are  washed  off.  The 
last  is  allow^ed  to  remain  on  from  five  to  ten  min- 
utes, or  until  a  tingling  sensation  is  produced,  then 
the  skin  is  washed  and  powdered  with  starch. 


HYSTERIA. 

Rest  Treatment : — The  essentials  of  this  treatment 
consist  of  Isolation,  Rest,  Diet,  Massage  and  Elec- 
tricity. The  following  is  a  general  outline  of  the 
method :  The  patient  should  be  removed  from  previ- 
ous surroundings,  av^ay  from  all  relations  and 
friends,  even  correspondence  being  interdicted  for  a 
time.  The  next  essential  is  an  intelligent  and  sensi- 
ble nurse,  the  selection  of  whom  is  a  matter  of  great 
importance ;  she  must  not  only  be  agreeable  and  con- 
genial to  the  patient,  for  it  must  be  remembered  she 
is  to  be  her  constant  and  only  companion  for  some 
months,  but  she  must  also  possess  tact,  judgment, 
and  firmness.  Under  the  nurse's  care  the  patient  is 
put  to  bed  and  kept  in  a  condition  of  absolute  rest, 
even  reading  and  self-feeding  at  first  being  prohibited. 
Massage  is  used  daily  at  the  commencement  for 
short  periods,  which  are  gradually  increased  until  it 
is  continued  for  an  hour.  Faradism  is  also  adminis- 
tered in  association  w^ith  massage ;  but  these  meas- 


346  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

ures  are  discontinued  during  menstruation.  The  diet 
during  this  period  is  milk,  used  b3'  some  skimmed, 
but  unskimmed  milk  diluted  with  aerated  water  is 
preferable ;  from  4  to  6  ounces  are  given  ever^  two 
hours.  This  diet  is  continued  as  a  rule  for  a  week  or 
ten  days,  when  a  chop,  raw  03'sters,  with  a  cup  of 
tea  or  coffee,  are  added  at  luncheon,  later  an  egg  and 
bread  and  butter  at  breakfast ;  the  milk  is  continued 
every  two  hours. 

The  nurse  should  give  the  patient  a  thorough 
sponge  bath  daily.  In  a  month  or  six  weeks  the  pa- 
tient is  allowed  to  sit  up  for  a  short  time,  after  that 
for  a  longer  period,  increasing  each  daj^  until  the 
whole  day  is  spent  out  of  bed.  This  return  from  the 
long  rest  in  bed  must  be  very  gradual.  Later,  the 
patient  is  taken  out  for  a  drive,  then,  in  time,  for  a 
short  walk,  then  gradually  for  longer  walks,  each 
time  increasing  the  distance,  until  long  distances  are 
covered  with  little  fatigue.  As  a  rule,  about  three 
months  w411  be  necessarj^  to  carry  out  this  treat- 
ment, w^hich  has  given  most  satisfactory  results. 
(S.  W.  M.) 

For  a  fuller  description  the  reader  is  referred  to 
Weir  Mitchell's  book,  "Fat  and  Blood,"  and  Good- 
no's  "  Practice  of  Medicine." 


ICHTHYOSIS. 

Treatment,  though  largely  palliative,  must  be 
active  and  continuous.  The  skin  should  be  kept 
moist  and  supple  by  frequent  warm  baths  with 
alkalis  and  soap,  the  free  use  of  Russian  baths,  and 
bj^  prolonged  warm  baths  followed  by  inunctions  of 
vaseline,  glycerine,  lanolin,  or  oil. 


ICHTHYOSIS.  347 

Sapo  Viridis: — This  maybe  rubbed  in  twice  daily 
for  four  or  six  days,  during  which  period  the  patient 
should  not  bathe;  four  or  five  daj^s  after  the  last 
rubbing,  w^hen  the  epidermis  begins  to  peel,  a  bath  is 
to  be  administered  followed  by  some  simple  oint- 
ment, such  as  oil  of  almonds,  glycerine,  pure  or 
diluted,  or  the  following : 

9;.    Adipis  Benzoatis,  ^iv. 

Ung.  Petrolii,  ^J- 

Glycerini,  9iv. 

M.  (Vn.) 

Naphthol: — 5  per  cent,  ointment,  or  2  per  cent,  in 
spirits  of  soap.     (Kap.) 

Resorcin : — 3  to  20  per  cent,  ointments  well  rubbed 
in  and  covered  with  bandages,  have  been  successful. 
(Ja. )  Brocq  recommends  the  following  to  be  rubbed 
in  at  night  and  removed  with  soap  in  the  morning : 

9. 


Acid.  Salicylici, 

Acid.  Tartarici, 

Resorcini, 

aa  3j. 

Sulphur.  Prsecipitati, 

3iiss, 

Adipis, 

5J- 

Lanolini, 

^iij. 

M.  (Vn.) 

Ichthyol : — In  combination    with    Salicylic    Acid 
and  Sulphur  may  be  employed  as  follow^s : 

Jfc.    Ichthyoli,  3Jj-iv. 

Acid.  Salicylici,  3J. 

Sulphur.  Prsecipitati,  gij. 

Adipis,  5  iv. 
M. 

Sig.     To  be  applied  night  and  morning  and  washed  off  with 
ichthyol soap. 


348  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Potass.  Iodide: — The  following  is  said  to  act  well: 

9;.    Potass.  lodidi,  gr.  xx. 

Ol.  Bubuli, 

Adipis,  aa  ^ss. 

Glycerini,  3J. 

M.        ^  (J.  C.  S.) 

Cod  Liver  Oil  by  inunction  and  Sulphur  Ointment 
are  both  recommended. 


ICHTHYOSIS  HYSTRIX. 

The  treatment  is  essentially  that  of  any  warty, 
non-malignant  grow^th.  The  patches,  if  not  large, 
may  be  softened  by  poultices  and  then  treated  with 
Caustic  Potash,  Chromic  Acid,  or  Glacial  Acetic 
Acid,  or  the  growths  may  be  removed  by  the  dermal 
curette  or  by  excision. 

Thuja: — The  fluid  extract  painted  on  has  had  good 
effect.     (Vn.) 

Salicylic  Acid: — A  20  percent,  plaster  or  a  satur- 
ated alcoholic  solution  is  recommended  after  the 
removal  of  the  homy  covering.     (B.  H.) 


IMPETIGO. 

According  to  Duhring,  this  affection  tends  to  spon- 
taneous recovery,  and  beyond  the  use  of  a  mild  stim- 
ulating ointment  no  treatment  is  required. 

The  following  line  of  treatment  is  suggested  by 
Van  Harlingen :  Poultices  rendered  antiseptic  b^'  the 
addition  of  a  little  Boric  Acid  should  be  used  to  re- 
move the  crusts ;  the  entire  surface  of  the  body  should 
be  frequently  cleansed  with  warm  water  and  Cor- 
rosive Sublimate  Soap,  then  compresses  ^vet  w^ith  a 


IMPETIGO  CONTAGIOSA.  349 

saturated  solution  of  Boric  Acid  or  of  Mercuric 
Bichloride,  1-2000,  should  be  applied  to  the  dis- 
eased points.  If  ulcers  form  beneath  the  crusts  they 
should  be  cleansed  with  Hydrogen  Peroxide  and 
dusted  with  Dermatol,  Europhen  or  Aristol,  or  some 
antiseptic  ointment  may  be  applied. 

Iodoform  and  Salicylic  Ointments  are  also  useful. 


IMPETIGO   CONTAGIOSA. 

Children  suffering  from  this  disease  should  be  kept 
from  school  and  separated  from  other  children. 

Hydrarg.  Ammoniat.: — This  remedy  is  very  gener- 
ally used  by  dermatologists,  and,  together  with 
cleanliness,  in  most  instances  is  all  that  w^ill  be  re- 
quired. It  is  employed  in  ointments  of  5  to  15  grains 
to  the  ounce.     (Hd.) 

Bismuth  Subnitrate: — With  vaseline  or  cold  cream, 
a  drachm  to  the  ounce.     (Al.) 


INFLUENZA. 

See  Acute  Rhinitis. 

INGROWING  TOE  NAIL. 

The  following  method,  it  is  claimed,  will  result  in  a 
permanent  cure : 

1.  Remove  injurious  pressure,  and  order  careful 
measurement  for  shoes,  the  uppers  of  which  should 


350  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

be  of  a  less  unyielding  nature  than  usual;  during 
actual  treatment  the  patient  should  wear  canvas 
shoes. 

2.  Wash  the  feet  with  warm  water  and  soap,  then 
soak  for  fifteen  minutes  in  bichloride  of  mercury,  1- 
4000 ;  repeat  this  daily  for  four  da\^s. 

3.  A  small  piece  of  antiseptic  gauze  is  to  be  grad- 
ually and  gently  inserted  between  the  nail  and  over- 
lying tissue ;  this  must  be  done  gently,  otherwise  it 
is  very  painful ;  the  gauze  should  be  removed  before 
washing. 

After  this  the  tissue  will  become  considerably  sep- 
arated from  the  nail,  which  can  be  trimmed  where  in 
contact  with  the  soft  parts.  After  soaking,  the 
gauze  is  to  be  inserted  as  before.  Within  a  week,  it 
is  said,  the  parts  will  have  assumed  almost  a  normal 
appearance,  and  the  patient  will  be  able  to  go  about. 
The  gauze  should  be  continued  for  some  weeks. 

A  modification  of  this  plan  has  been  found  useful, 
viz.:  In  place  of  the  soaking,  apply  a  compress  satur- 
ated in  a  solution  of  carbolic  acid  or  perchloride  of 
iron  and  cover  the  same  w^ith  rubber  tissue.  After 
tv^o  days'  application,  the  gauze  may  be  used  as 
above  and  the  nail  trimmed.     (T.,  98.) 

The  following,  suggested  by  Dr.  M.  O.  Terry,  is 
also  said  to  be  successful :  Saturate  a  small  piece  of 
absorbent  cotton  in  a  solution  of  Liquor  Potassae  1 
part  to  4  parts  of  water ;  then,  with  the  flat  end  of 
a  director,  insert  the  cotton  under,  over  and  above 
the  edge  of  the  nail,  allowing  it  to  spread  over  the 
ulcerated  hypertrophied  tissues;  next  freely  apply 
collodion  over  the  whole,  including  the  inflamed  sur- 
face; after  this,  with  a  long,  narrow  strip  of  surgical 
isinglass  plaster,  attach  an  end  close  to  the  nail  on 


INGROWING  TOE  NAIL.  351 

the  swollen  part  and  bring  it  around  the  toe  two  or 
three  times,  drawing  the  hypertrophy  aw^ay  as  much 
as  possible ;  if  the  case  is  bad,  it  will  require  four  or 
five  dressings,  which  should  not  be  changed  under 
forty-eight  hours .     ( Hel . ) 

An  old  method,  which  will  sometimes  afford  relief 
in  the  earlier  stages,  consists  of  scraping  in  a  line 
from  the  matrix  to  the  extremity  of  the  nail ;  the  ex- 
ternal la3^er  may  be  thus  removed  ;  when  the  middle 
is  reached  there  will  be  sensitiveness  and  the  scraping 
must  cease ;  a  deep  notch  is  now  cut  in  the  extremity 
of  the  nail.  The  ingrowing  parts  are  now  to  be 
partly  raised  with  a  probe  and  small  bits  of  tinfoil 
inserted ;  a  hole  should  be  cut  in  the  boot  to  relieve 
pressure.  This  process  of  scraping  and  notching 
should  be  continued  for  several  weeks,  w^hen  a  cure 
will  result.     (Hel.) 

Collodion: — Pack  cotton  firmly  under  the  free  edge 
of  the  nail  with  a  flat  probe  passing  between  the  nail 
and  the  granulations,  raising  the  former  as  far  as 
possible ;  the  cotton  having  been  thus  packed  under 
and  around  the  nail,  saturate  the  entire  mass  with 
collodion ;  after  drying  apply  a  few  strips  of  adhesive 
plaster.     (Al.) 

Nitrate  of  Silver: — Apply  a  sharp-pointed  crayon 
to  the  base  or  under  the  surface  of  the  granulations, 
then  insert  a  small  piece  of  lint  soaked  in  black  v^ash, 
and  envelop  the  toe  in  water  dressing.     (Al.) 

Tannic  Acid: — 1  part  to  6  of  water,  dissolved  by 
gentle  heat  and  painted  on  soft  parts  twice  daily 
has  given  good  results.     (Al.) 

Calendula: — Very  useful  for  the  relief  of  inflamma- 
tion ;  compresses  soaked  in  a  solution  of  1  part  to  5 
of  carbolized  water  maj^  be  applied  with  good  effect. 
(M.  H.) 


352  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Alum: — A  solution  of  6  drachms  to  1  ounce  of  hot 
water  is  very  effective  for  inflammations.     (W.  C.) 

Cocaine  : — This  remedj^  is  most  useful  for  the  relief 
of  pain  in  dressing;  also  after  appl^nng  a  ligature 
around  the  toe,  it  may  be  given  hypodermicalh',  and 
thus  render  removal  of  the  whole  or  part  of  the  nail 
entirely  painless.     (Tre.) 

Antiseptic  dusting  powders  ^vill  be  found  useful  in 
ulceration,  notably  Bismuth  Subnitrate.     (Al.) 

Removal  of  the  nail  is  sometimes  necessary. 


INSOMNIA. 

Warm  or  Tepid  Baths  at  night.  Massage  or  the 
Wet  Pack  are  all  of  value.     (Gn.) 

Injections  of  Hot  Milk  high  into  the  bowel  is  use- 
ful in  cases  of  alcoholism  and  insanity 

Inhalations  of  a  mixture  of  70  per  cent,  of  Oxygen 
^^n±h  30  of  nitrogen  gas  administered  before  retiring 
are  often  effective  in  inducing  sleep. 


IRITIS. 

Local  or  mechanical  treatment  is  of  the  greatest 
importance  to  prevent  adhesion  of  the  iris  to  the  cap- 
sule of  the  lens;  this  is  accomplished  by  mydriatics. 

Atropine  Sulphate: — This  is  commonly  used,  and  in 
most  cases  preferred  to  other  mj'-driatics,  on  account 
of  its  sustained  action ;  a  drop  of  the  1  per  cent,  solu- 
tion is  placed  on  the  outer  surface  of  the  conjunctiva 
of  the  lower  lid,  the  patient  holding  the  head  back  so 
that  the  outer  canthus  is  low^er  than  the  inner.    In 


IRITIS.  353 

acute  cases  of  plastic  iritis  1  drop  of  a  1  per  cent, 
solution  should  be  dropped  in  the  eye  every  two 
hours  during  the  active  stage.     (Mac.) 

Scopolamine: — A  solution  of  2  grains  to  the  ounce 
of  distilled  water,  is  a  better  mydriatic  in  persons 
over  50  years  of  age  and  in  cases  where  glaucoma  is 
threatening,  as  atropine  will  precipitate  an  attack  of 
the  latter  and  will  make  it  worse  if  present.  This 
m3^driatic  is  more  active  than  atropine  and  wall  tear 
up  adhesions  quicker.  (Boyle.)  For  quick  action, 
which  is  necessar\'  in  plastic  iritis,  scopolamine  hy- 
drobromate,  in  solutions  of  y^  of  1  per  cent.,  is  to  be 
preferred  to  atropine,  using  2  drops  at  a  sitting,  re- 
peating as  necessary.     (T.,  98.) 

Cocaine  Hydrochlorate  : — 2  per  cent,  solutions  are 
used  to  relieve  pain.  (T.,  98.)  This  remedy  is  fre- 
quently combined  with  atropine,  not  only  for  its 
anaesthetic  effects,  but  because  it  assists  in  dilating 
the  pupil  by  its  action  on  the  iris  and  by  increasing 
the  absorbing  power  of  the  cornea.     (Al.) 

Duboisin  Sulphate: — One-half  per  cent,  solutions 
ma^'  be  used  when  atropine  causes  irritation  of  the 
skin  or  the  conjunctiva.     (T.,  98.) 

Hyoscine  Hydrobromate: — 1  drop  of  a  1  per  cent, 
solution  maj^  be  instilled  in  cases  w^here  the  adhe- 
sions are  so  strong  that  they  resist  the  action  of 
atropine.  It  is  a  very  powerful  remedy,  and  should 
only  be  used  by  the  physician  himself;  the  action 
may  be  kept  up  by  atropine.     (Mac.) 

Cold: — Applicable  in  three  w^ays;  in  the  first  place, 
tie  a  piece  of  tape  around  the  patient's  head  and  to 
it  attach  a  square  of  linen  which  covers  the  inflamed 
eye,  a  basin  of  ice  water  is  placed  conveniently  near 
and  from  it  the  square  of  linen  is  kept  constantly 
24 


354    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

moistened.  The  second  method  consists  of  the  appli- 
cation of  a  pad  of  cotton  wool  \vhich  has  been  laid 
upon  a  block  of  ice  and  which  is  changed  as  soon  as 
it  ceases  to  give  the  sensation  of  cold.  A  block  of  ice 
is  placed  near  the  bed-side  and  two  pads  kept  in  use, 
one  cooling  on  the  ice  while  the  other  is  on  the  lids. 
The  third  plan  is  a  modification  of  Leiter's  coil,  being 
the  same  apparatus,  but  of  much  lighter  construc- 
tion and  especially  adapted  to  this  purpose.     (N.  O.) 

Heat : — May  be  applied  either  in  the  moist  or  dry 
form.  Several  folds  of  lint  are  dipped  in  hot  water, 
squeezed  out  as  dry  as  possible,  applied  to  the  lid 
and  covered  with  oiled  silk.  This  dressing  is  then 
packed  in  with  a  thick  layer  of  dry  cotton  heated  by 
contact  with  a  can  or  pail  containing  hot  water,  and 
bandaged  in  position.  Another  and  equally  effective 
way  consists  of  the  rapid  application  of  a  fold  of 
linen  which  has  been  wrung  in  hot  water  and  \vhich 
is  rapidl3'  replaced  as  soon  as  cool.  Hot  infusions  of 
Chamomile  Flowers  or  Poppies  are  permissible, 
also  Conium  Lotion,  a  drachm  of  the  extract  to  a 
pint  of  water,  or  Belladonna  in  the  same  propor- 
tions. Hot  applications  are  useful  during  the  early 
stage  of  the  disease  (Ro.),  and  may  be  ordered  two 
or  three  times  a  day,  for  half  hour  at  a  time.  It 
is  advisable  when  the  skin  is  sensitive  to  protect  the 
lid  and  neighboring  parts  with  vaseline.     (N.  O.) 

Dry  heat  can  be  applied  by  covering  the  lid  with  a 
pad  of  cotton  which  has  been  heated  by  contact 
with  the  outside  of  a  vessel  containing  boiling 
water.     (N.  O.) 

Local  Abstraction  of  Blood: — A  time-honered  rem- 
edy, may  be  used  if  pain  and  vascular  injection  is 
very  severe.  Natural  or  artificial  leeches  may  be 
used.     (Ro.) 


KELOID.  355 

INTERTRIGO. 

See  Erythema  Intertrigo. 


KELOID. 

Treatment  is  unsatisfactory.  Removal  by  the  knife 
is  generally  followed  by  recurrence.  Electrolysis  is 
probably  the  best  means.     (Hd.) 

Thiosinamine: — 10  to  15  minims  of  a  10  per  cent, 
solution  hypodermically,  have  been  employed  with 
good  results.     (Hd.) 

Vidal's  Method: — Deep  parallel  incision  dividing 
the  vessels,  producing  obliteration,  may  have  a  bene- 
ficent effect,  if  done  repeatedly.  It  usually  relieves 
pain.     (B.  H.) 

Anodyne  Applications  may  be  required  for  the 
relief  of  pain. 

KERATITIS. 

Atropine : — Renders  great  service  by  contracting 
vessels;  it  is  useful  in  all  forms  according  to  the 
condition.     (Ro.) 

Eserine: — In  the  phlyctenular  variety,  a  solution 
of  one  five-hundredth  dropped  into  the  eye  three 
times  a  day  will  be  found  valuable  in  hastening  the 
healing  of  the  ulcers,  and  in  relieving  the  photo- 
phobia by  contracting  the  pupil  and  reducing  the 
tension  of  the  eyeball.  As  iritis  is  seldom  a  compli- 
cation, this  remedy  is  generally  safe.     (Mac.) 

Pyoktanin: — Solutions  of  1-1000  in  the  parenchy- 
matous and  sloughing  forms  are  highly  praised  as 
well  as  discredited.     (Al.) 


356  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Cocaine : — Alone  or  in  combination  with  atropine 
to  relieve  pain  and  check  inflammation.     (Al.) 

Gallicine: — In  superficial  forms,  the  powder,  which 
is  very  light,  may  be  dusted  on,  the  application  being 
made  twice  a  w^eek;  a  smarting  sensation  follows, 
v^rhich  soon  passes  off,  or  which  can  be  relieved  by 
cold  compresses  or  cocaine.     (F.) 

Hot  Stupes: — Of  great  value,  especially  when  there 
is  sloughing,  in  which  case  they  are  indispensable. 
They  may  be  of  service  in  all  forms  according  to  indi- 
cations.    (Al.) 

Cauterization: — The  actual  cautery  or  pure  car- 
bolic acid  is  effective  in  the  suppurative  variety. 
(Ro.) 

Iodoform : — Dusted  on  or  applied  as  an  ointment 
(sj-gj)  is  favorably  regarded  by  some  when  there  is 
sloughing,  but  should  not  be  relied  upon  to  the  ex- 
clusion of  other  remedies.     ( Al.) 

Hydrarg.  Oleat.: — The  ointment  by  inunction  in 
the  diffuse  form  may  be  employed  for  months,  but 
with  great  caution.     (Ro.) 

Aristol : — The  powder  has  been  employed  with  suc- 
cess in  clearing  opacities  of  the  cornea  in  interstitial 
keratitis.     (Sm.) 

Mercury: — Finely  levigated  Calomel  as  a  dusting 
powder  or  the  Yellow  Oxide  as  an  ointment  (gr.  ss- 
iv-^j)  are  recommended  for  chronic  cases.     (Al.) 


LARYNGISMUS  STRIDULUS. 

Raise  the  child  and  promptly  immerse  it  in  a 
"Warm  Bath,  sponging  the  throat  at  the  same  time 
v^ith  hot  water,  and  apply  a  Sinapism  to  the  back 
of  the  neck.    (Bos.) 


LARYNGITIS.  357 

Anaesthetics  will  stop  an  attack  immediately;  a 
few  drops  of  Ether  will  generally  answer.  Chloro- 
form may  be  used  for  the  convulsions  which  may 
follow^ 

Ice  to  the  epigastrium  or  in  the  rectum  sometimes 
will  afford  prompt  relief. 

Cold  \Vater  dashed  on  the  face  with  considerable 
force  may  be  tried  to  excite  respiration. 

Irritation  of  the  Pharynx  with  the  finger  or  w^ith  a 
feather  to  induce  vomiting  will  relax  the  spasm. 
(Gn.) 

The  child  should  be  placed  in  a  semi-recumbent 
position,  Avith  free  access  to  the  air,  and  the  tongue 
should  be  watched,  lest  it  fall  back  into  the  pharynx 
and  still  further  impede  respiration. 

Artificial  Respiration  should  be  employed  when 
spasm  is  prolonged  and  death  seems  imminent.  (Gn.) 

Chloral  Hydrate  : — 4  to  8  grains  by  rectal  injection 
are  recommended  for  the  convulsions  which  not  un- 
commonl3^  follow^  an  attack.     (Jac.) 

The  condition  of  the  gums  and  bowels  should  be 
investigated  as  possible  causes. 


LARYNGITIS. 

ACUTE  CATARRHAL  LARYNGITIS. 

The  temperature  of  the  room  should  be  evenly 
maintained  at  about  70°  F.,  and  the  atmosphere 
kept  moistened  with  Steam. 

Heat: — Applied  to  the  throat  increases  secretion, 
and  relieves  congestion ;  it  is  useful  in  most  cases. 
Flannel  cloths  wrung  out  in  hot  water  and  covered 


358  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

^th  oiled  silk  are  the  best  methods  of  application ; 
poultices  may  be  used,  but  they  are  heavy  and  incon- 
venient. A  hot  foot  bath  is  often  beneficial  at  the 
onset  of  the  disease.    ( Ga. ) 

Cold: — Applied  by  means  of  the  ice  bag,  or  cold 
•wet  cloths  frequently  changed,  will  often  cut  short 
an  attack  if  undertaken  early  enough  (Bos.);  these 
measures  are  also  often  of  service  in  grave  forms  of 
the  disease  attended  \\'ith  swelling  of  the  submucous 
tissue. 

Inhalations  of  warm  medicated  vaf>ors  are  of  ser- 
vice. The  following  are  to  be  used  with  boiling 
water: 

Tr.  Benzoin  Comp.,  jss— j-Oj. 

Turpentine,  .^j,  jx)ured  on  the  surface  of  a  pail  of 
boiling  water. 

Thymol,  1—1000,  useful  in  exanthematous  forms 
^th  purulent  exudation- 

Oil  of  Origanum,  gtt.  ij-iv— Oj. 

Oil  of  Cubebs,  indicated  when  there  is  relaxation 
of  the  mucus  membrane  and  hypersecretion,  10  drops 
to  1  ounce,  add  a  small  quantity  of  magnesia  car- 
bonate ;  of  this  mixture  take  1  drachm  to  half  a  pint 
of  water. 

Lupulin,  gr.  v-^,  strongly  recommended  if  there  is 
great  pain  and  rapid  progress  of  the  disease. 

Astringent  sprays  may  be  used  as  follows : 

Liq.  Ferri  Persulphatis,  gtt.  v— x— ^. 

Argenti  Nitras,  gr.  ij— v— 4J, 

Zinci  Chloridum,  gr.  v— x— ^. 

Dobell's  Solution,  or  some  other  mild  alkaline 
spray,  should  be  employed  for  cleansing  when  there 
is  an  excess  of  mucus. 

For  the  administration  of  steam  inhalations  em- 


LARYNGITIS.  359 

plov  one  of  the  special  appliances  constructed  for 
this  purpose,  or  an  ordinary  hot  water  kettle  with  a 
piece  of  rnbber  piping  attached  to  the  nozzle;  for 
want  of  something  better  a  common  tin  funnel 
placed  over  a  cup  of  hot  water  will  ansA^er. 

The  following  measures,  stated  in  order  of  the  im- 
portance, are  suggested  by  Bosworth  for  hoarseness 
and  complete  loss  of  voice,  especially  in  singers  and 
public  speakers,  where  speedy  relief  is  a  matter  of  im- 
portance. There  is  no  definite  method,  however,  by 
which  relief  can  be  obtained  in  a  given  period :  1. 
Absolute  and  total  rest  of  the  voice ;  this  is  literal, 
even  whispering  is  to  be  avoided  as  much  as  possible. 
2.  Confinement  to  an  apartment  the  temperature  of 
which  should  be  evenly  maintained  at  68°  or  70°, 
not  higher.  3.  Let  the  atmosphere  be  impregnated 
with  steam  from  a  spirit  lamp.  4.  Apply  an  ice  bag 
to  the  surface  of  the  throat.  5.  By  means  of  an 
atomizer,  spray  the  larynx  with  a  solution  of  nitrate 
of  silver,  gr.  v— 5J,  repeat  a  second  or  a  third  time 
during  the  day,  the  streng^th  of  the  solution  and  the 
interval  of  application  being  governed  by  the  ap- 
pearance of  the  parts  as  shown  by  the  laryngoscope. 
6.  Reduce  turbinated  bones  if  swollen  by  chromic 
acid.  7.  If  there  is  acute  inflammation  of  the 
pharynx  douche  the  part  thoroughly  with  the  post- 
nasal syringe  and  apply  nitrate  of  silver,  gr.  xxx— ^. 

(In  conjunction  with  these  measures  -^  grain  of 
aconitine  hourly  for  three  doses,  then  every  two 
hours  until  constitutional  effects  are  produced,  and  a 
saline  purge.)     (Bos.) 

CHRONIC  CATARRHAL  LARYNGITIS. 

Many  w-riters  regard  this  disease  as  always  sec- 
ondary to  some  other  chronic  affection  of  the  upper 


360  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

respiratory  tract,  as  such,  treatment  should  also  be 
directed  to  the  primary  disease. 

Direct  instrumental  indications  require  the  per- 
sonal attention  of  the  physician.  Inhalations  and 
insufflations  may  be  carried  out  by  the  patient  or  an 
attendant  at  home. 

Alkaline  Sprays  tend  to  increase  secretion  and  fa- 
cilitate removal  of  adherent  mucus ;  for  this  purpose 
employ  the  follo-wing,  each  in  the  proportion  of  5 
grains  to  the  ounce  of  water  (Solis  Cohen) :  Am- 
monium Chloride,  Sodium  Borate,  Sodium  Bi- 
carbonate, Sodium  Chloride,  Potassium  Chlorate. 
Tar  ^Vater  may  be  used  as  a  menstrum  instead  of 
distilled  water.  A  few  drops  of  some  aromatic  may 
be  added  to  the  solutions  to  make  them  more  agree- 
able.    (Pp.) 

Astringent  Sprays  are  indicated  when  secretion  is 
excessive.  The  following  are  to  be  employed  with 
one  ounce  of  rose  water : 

Alumen,  gr.  v. 

Acidum  Tannicum,  gr.  ij. 

Plumbi  Acetas,  gr.  ij. 

Ferri  Chloridum,  gr.  j. 

Argenti  Nitras,  gr.  ss. 

Zinci  Acetas,  gr.  v. 

Zinci  Sulphas,  gr.  ij. 

Zinci  Sulpho-Carbolas,  gr.  ij. 

Vegetable  astringents,  iodine,  carbolic  acid  and 
creosote,  are  condemned  by  some  writers  as  in- 
effectual. 

The  following  in  the  proportion  of  the  amount 
mentioned  to  an  ounce  of  v^^ater,  preference  of  selec- 
tion being  given  according  to  order,  are  recom- 
mended : 


LARYNGITIS.  361 

Argenti  Nitras,  gr.  v— xx. 

Zinci  Sulphas,  gr.  v— xx. 

Zinci  Chloridum,  gr.  ij— vj. 

Liq.  Ferri  Persulphatis,  M.  x— xxx. 

Cupri  Sulphas,  gr.  iij— x. 

Steam  Inhalations : — Used  at  home  daily  are  ser- 
viceable in  cases  of  hyperaesthesia  of  the  mucous 
membrane.  The  patient  should  remain  indoors  for 
half  an  hour  after  use.  The  following  are  to  be  em- 
ployed, all  in  the  proportion  of  a  teaspoonful  of  the 
mixture  to  a  pint  of  hot  water : 

9;.    Tr.  Benzoin.  Comp.,  gxxij. 

01.  Pini  Silvestris,  gij. 

M. 

Stimulating  and  soothing. 

5fc.    Ol.  Pini  Silvestris, 

Magnesise  Carb.  L,evis,  aa  3J. 

Aq.  Destill.,  ad  ^iij. 

M.  (L.  B.) 

This  forms  a  mildly  stimulating  and  resolving  ap- 
plication. The  same  formula  may  be  employed  w^ith 
the  addition  of  5  grains  of  camphor. 

Other  useful  formulae  used  in  the  same  proportion 
are  as  follows : 

9.    Ol.  Eucalypti,  3J-iij- 

Magnesise  Carb.  Levis,  gr.  xxx-xc. 

Aq.  Destill..  ,^iij. 

M. 

An  agreeable  stimulant  with  sedative  effect : 

T^.    Creosoti,  ^ss. 

Magnesiae  Carb.  Levis,  3;iss. 

Aq.  Destill.,  ad  ^iij. 
M. 


362  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Usefiil  for  chronically  congested  conditions : 


Benzoli, 

3ij- 

Ol.  Cassiae, 

M.vj. 

Magnesiae  Carb.  Levis, 

3J; 

Aq.  Destill., 

ad  ^iij. 

M.  (L.  B.) 

If  topical  treatment  of  a  more  decided  character  is 
indicated,  solutions  applied  with  a  brush,  or  pow^- 
ders  should  be  used,  but  only  in  the  hands  of  an  ex- 
pert, as  spasm  of  the  larynx  is  liable  to  be  excited  by 
medicinal  applications  when  made  for  the  first  time. 
Remedies  of  this  nature  should  not  be  employed  until 
tolerance  has  been  established.  The  use  of  cocaine 
w^ill  greatly  assist  in  allaying  irritation.    (L.  B.) 

Among  the  stronger  local  applications  which  have 
been  suggested  for  intra-laryngeal  treatment  are  the 
following : 

lodoforni: — Indicated  in  ulceration,  finely  pulver- 
ized, alone  or  with  Bismuth  equal  parts,  with  Mor- 
phine gr.  ij-x  to  the  §j  of  iodoform  (Ty.),  or  in  an 
ethereal  solution. 

Nitrate  of  Silver: — Gr.  xxv,  rose  water,  |j,  recom- 
mended by  Solis  Cohen  in  obstinate  and  protracted 
cases  (Pp.),  condemned  by  Lennox  Brown,  but  re- 
garded by  other  writers  as  effective. 

Iodine: — Gr.  j,  glycerine  §j  (L.  B.),  or  iodine,  gr.  v, 
in  alcohol,  3j—viij  ;  applications  are  made  daily  com- 
mencing w^ith  the  v^eaker  solutions ;  only  one  puif  is 
to  be  applied,  the  patient  inspiring.  Holding  cold 
w^ater  in  the  mouth  may  control  spasm.  The  pre- 
vious use  of  a  strong  solution  of  cocaine  w^ill  usually 
act  as  a  preventive.     (Gn.) 

Chloride  of  Iron: — ^3ss-5J,  with  water,  5j,  has  been 
used   in  the  hoarseness  of  professional  singers;    a 


LARYNX,   CEDEMA  OF.  363 

single  application,  it  is  said,  will  often  put  the  parts 
in  good  condition.     (Al.) 

Faradism  is  of  benefit  in  restoring  the  tone  and 
power  of  the  voice.  Cold  V/et  Compresses  at  night 
and  Iodine  painted  on  the  throat  over  the  thyroid 
cartilage  are  useful  adjuncts.     (L.  B.) 

Lactic  Acid,  Nitrate  of  Silver  or  Chromic  Acid 
fused  on  the  end  of  a  silver  probe,  applied  with  a 
properly  hooded  porte-caustique,  may  be  applied  in 
some  cases  when  there  is  considerable  hypertrophy 
at  the  posterior  insertion  of  the  chords  and  anterior 
face  of  the  commissure,  giving  rise  to  w^atery  excres- 
cences. The  use  of  caustics  is  generally  condemned 
except  for  the  above  condition,  which  is  occasionally 
observed. 


LARYNX,  CEDEMA   OF— CEDEMA 
GLOTTIDIS. 

Free  Scarification: — Such  local  depletion  as  can  be 
obtained  by  free  scarification  of  the  inflamed  mem- 
brane is  the  first  indication.  This  can  be  accom- 
plished by  Tobold's  concealed  lancet  or  any  other 
laryngeal  knife  convenient ;  if  this  is  not  at  hand  use 
an  ordinary  curved  bistoury  -with  the  blade  v^rapped 
in  plaster  or  thread  up  to  within  a  quarter  of  an 
inch  of  its  point.  The  scarifications  should  be  used 
freely  three  times  a  day  both  along  the  face  of  the 
epiglottis  and  the  swollen  venticular  cords.     (Bos.) 

Ice  : — Applied  to  the  neck  has  been  employed  w^ith 
good  results ;  the  patient  should  also  be  allowed  to 
suck  ice. 


364        DIGEST   OF   EXTERNAL  THERAPEUTIC*. 

Cocaine  Sprays  and  Steam  Inhalations  are  ad- 
vised. 

Pilocarpine  : — Hypodermically  administered  has 
been  successful  in  some  cases ;  in  those  of  a  sthenic 
type  it  is  strongly  advised.     (Ty.) 

Tracheotomy : — Should  be  performed  if  no  relief  is 
obtained.  The  high  rate  of  mortality,  according  to 
Osier,  is  due  to  the  fact  that  in  many  instances  the 
operation  is  delayed  too  long. 


LARYNX,  TUBERCULOSIS  OF. 

See  Tuberculosis. 

LENTIGO— FRECKLES. 

The  remedies  for  chloasma  are  also  applicable. 

Copper  Oleate: — Gr.  v-3-§j,  with  lanolin  or  lard  is 
excellent.     (Sh.) 

Salicylic  Acid: — Gr.  iv.-§j,  in  an  ointment.    (Sh.) 

Hydrarg.  Bichlorid.: — Used  in  strengths  varying 
from  one-half  to  4  grains  to  the  ounce  of  water,  al- 
cohol or  almond  oil.  These  solutions  may  be  left  in 
contact  Tvith  the  skin  several  hours.     (B.  H.) 

The  follow^ing  are  useful  combinations : 

9;.    Hydrarg.  Bichlorid.,  gr.  ss. 

Tr.  Benzoini.,  5^^®®- 

Glycerini,  5ij. 

Aq.  Rojae,  ,^vj. 

M.  (Sm.) 


LEPROSY.  365 

Or  the  following  paste  of  Unna,  which  is  to  be  ap- 
plied once  daily : 


Hydrarg.  Bichlorid., 

gr.  ii 

Zinc.  Oxidi, 

3ij- 

Bismuth.  Oxychloratis, 

3ss. 

Dextrini, 

Aq.  Destill., 

aa  3ij. 

Glycerini, 

3"]- 

M. 

Carbolic  Acid: — Touch  each  spot  with  the  pure 
acid ;  as  a  result,  the  epidermis  w^ill  peal  off  and  leave 
a  red  spot  w^hich  will  become  normal  in  a  few  days. 
(Sh.) 

Zinc  Sulpho-Carbolate: — A  paste  for  application 
with  a  brush  made  as  follows : 


9;.    Zinc.  Sulpho-Carbolatis, 

gr.  V. 

Alcoholis, 

3SS. 

Collodii, 

IJ. 

M. 

(Al.) 

Hydrarg.    Ammoniat.: — May    be    combined    with 
Bismuth  as  follows : 

9;.    Hydrarg.  Ammoniati, 

Bismuth.  Subnitratis,  aa  3J. 

Ung.  Aq.  Rosae,  Jj. 

M.  (Hd.) 


LEPROSY. 

For  ulceration,  ordinary  antiseptic  methods  should 
be  employed.  Iodoform,  Aristol,  Salol,  Boric  Acid 
may  be  dusted  on  after  cleansing  with  antiseptic 
solutions.     (B.  H.) 

Oil  of  Anacardium: — Used  in  tropical  countries. 
As  a  local  stimulant  it  may  be  applied  pure,  but  is 


366  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

better  diluted  with  3  parts  of  almond  oil ;  applica- 
tions are  made  to  the  anaesthetic  spots  until  a 
blister  is  formed,  also  to  tubercles  until  they  open; 
the  lesions  are  then  dressed  with  gurjun  oil.     (Al.) 

Gurjun  Oil: — Recommended  on  good  authority; 
the  formula  for  its  use  is  1  part  of  the  oil  to  3  of  lime 
w^ater;  churn  well  together  so  as  to  make  a  cream 
and  apply  to  the  ulcers.  (Vn.)  Equal  parts  of  the 
oil  and  lime  water  are  also  emploj^ed.     (Al.) 

Chaulmoogra  Oil: — By  inunction  pure  or  with  vas- 
eline or  lard;  spread  on  cloths  and  apply  to  parts. 
Under  this  drug  improvement  may  be  looked  for. 

(F.) 
Ichthyol: — Applications  varjdng  from  10  to  60  per 

cent.,  reported  by  Unna  to  have  given  good  results. 

Hydrarg.  Bichlorid.: — Intra-muscular  injections  of 
^  grain  were  used  by  Crocker  in  two  cases  with  re- 
markable improvement;  it  is  believed  to  be  a  valu- 
able agent.     (T.,  97.) 

Serum  Treatment: — Claims  have  been  made  for 
the  treatment  of  de  Dios  Carrasquilla,  but  its  cura- 
tive power  has  not  yet  been  demonstrated.     (F.) 

Chrysarobin: — Recommended  by  Unna  in  the  fol- 
lowing combinations,  to  be  rubbed  into  all  the 
lesions  except  those  of  the  hands  or  face :  Chrysaro- 
bin and  ichthyol  of  each  5  parts,  acid  salicjdic  2 
parts,  simple  ointment  100  parts ;  on  the  hands  and 
face  Pyrogallic  Acid  is  substituted  for  the  chrysaro- 
bin (to  counteract  bad  eifects  of  the  drug  30  drops 
of  dilute  hydrochloric  acid  are  administered  daily,  for 
women  and  children) ;  Resorcin  is  sometimes  substi- 
tuted for  chrysarobin. 

Electro-Cauterization: — Has  been  used  as  a  means 
of  reducing  leprous  nodules ;  each  tubercle  should  be 


LEUCORRHCEA.  367 

cauterized  interstitially  by  single  or  multiple  points 
or  by  electro-caustic  bars  when  the  surfaces  to  be 
destroyed  are  large.     (T.  98.) 

Excision: — Followed  by  the  application  of  pure 
Carbolic  Acid,  is  a  method  which  has  been  employed 
with  a  view^  of  relieving  the  disfigurements ;  Tannin 
is  applied  to  the  surface  after  the  carbolic  acid  in 
order  to  form  a  crust  and  to  protect  the  action  of 
the  acid.  The  knife  or  scissors  are  used  for  excising. 
(B.  M.J.,  6,  9,  88.) 


LEUCORRHCEA. 

Compare  Endocervicitis  and    Endometritis. 

Being  a  symptom,  treatment  is  obviously  to  be 
directed  toward  the  cause ;  when  of  cervical  origin, 
it  is  that  of  endocervicitis,  endometritis  and  erosion. 
Displacements,  hypertrophied  cervix,  lacerations, 
polypi,  cysts  and  vaginitis,  dyscrasia,  ascarides  in 
children  are  also  causes  which  must  be  considered. 

Douches: — Hot  water  douches  are  of  great  value 
in  all  forms  and  should  be  used  daily;  tepid  salt 
water  is  beneficial  for  simple  forms  of  catarrh.   (Cp.) 

Hydrastis: — One  of  the  most  useful  remedies.  The 
follow^ing  are  recommended  for  injection  : 


ife.    Fid.  Ext.  Hydrastis, 

3j. 

Aq.  Destill., 

Oss. 

M. 

Or, 

9;.    Fid.  Ext.  Hydrastis, 

Sue.  Calendulae, 

aa  Sj. 

Glycerini, 

Svj. 

M. 

Sig.     A  tablespoonful  to  half 

a  pint 

of  water.     (Cp.) 

368         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

9;.      Creolini,  gtt.  xxx. 

Fid.  Ext.  Hydrastis,  giiss. 

M. 

Sig.    2  tablespoonfuls  to  half  a  pint  of  water.     (T.,  97.) 

Borax: — 5  to  10  per  cent,  solutions,  often  very- 
satisfactory  in  alkaline  discharges.     (F.) 

Boric  Acid : — The  powder  by  insufflation  or  in 
solution  with  glycerine  tampons ;  also  used  in  solu- 
tion for  injection,  6  drachms  to  the  pint.     (R.) 

Tannin: — Used  in  several  ways;  half  an  ounce  \vith 
half  a  pint  of  claret  wrine  forms  a  good  astringent 
injection.  Also  the  follov^ing :  Creosote  3  parts,  tan- 
nic acid  6  parts,  alcohol  3  parts,  water  24  parts.  A 
tablespoonful  of  this  mixture  with  2  pints  of  water ; 
inject  two  or  three  times  a  day.     (T.,  98.) 

Alum: — A  very  useful  and  inexpensive  remedy ;  use 
about  a  drachm  to  a  pint  of  water  for  a  simple  in- 
jection. 

1^.    Aluminis,  3J- 

Zinc.  Sulphatis,  3^^. 

Sod.  Boratis,  gr.  jv. 

Aq.  Rosae,  ad  ^viij. 

M.  (R.) 

Or, 

Jfc.    Aluminis, 

Zinc.  Sulphatis,  aa  3j- 

Potass.  Permang., 

Heliotropin.,  aa  gr.  j. 

M. 

Sig.     Dissolve  this  powder  in  a  pint  of  warm  water  and  use  a 
a  vaginal  douche.     (T.,  97.) 

Argentamine: — Indicated  in  leucorrhoea  caused  by 
gonococcal  infection,  in  all  cases  of  vaginal,  cervical 
or  uterine  catarrh  in  which  there  is  a  muco-purulent 
or    purulent    discharge,    both    in  young   girls    and 


LEUCORRHCEA.  369 

adults,  and  in  discharges  dependent  upon  malignant 
growths.  The  strengths  of  the  solutions  are  as  fol- 
lows :  For  simple  vaginal  irrigation,  1-5000-4000 ; 
for  disinfection,  1-3000-2000-1000.     (N.  M.) 

The  following  combinations  are  also  recom- 
mended : 

Myrrh: — A  drachm  to  an  ounce  of  water  often  will 
have  an  excellent  effect  in  simple  catarrhal  condi- 
tions.    (Al.) 

Zinc  Sozoiodate: — As  a  dusting  powder  or  as  a  10 
per  cent,  ointment  on  tampons.     (Al.) 

Grindelia: — An  effective  remedy,  may  be  combined 
with  creolin  as  follows : 

^.    Fid.  Ext.  Grindeliae,  gss. 

Creolini,  5ij- 

Aq.  Destill.,  q.  s.  ad  .^v. 

M.  (Sm.) 

Loretin: — By  insufflation,  after  a  cleansing  douche 
this  drug  has  many  of  the  advantages  of  iodoform 
without  its  odor ;  it  is  especially  serviceable  in  puru- 
lent and  offensive  discharges.     (T.,  96.) 

In  some  chronic  cases,  benefit  is  derived  from  tam- 
pons soaked  in  Glycerine  of  Carbolic  Acid  1  part 
and  Glycerine  of  Tannin  4  parts,  introduced  through 
a  speculum.     (T.,  96.) 

Glycerite  of  Tannic  Acid  or  Gallic  Acid  are  also 
used  for  saturating  tampons.     (Sw.) 

Other  effective  injections,  viz.: 

9;.    Acid.  Salicylic!, 

Acid.  Thymici,  aa  3®^. 
Ess.  Ambrae  Griseae,  gtt.  xx. 

Alcoholis,  90°,  5viss. 

Aq.  Coloniensis,  5^^- 

Aq.  Destill.,  gix. 


M 


25 


370  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Sig.     A  tablespoonful  to  a  quart  of  water;  inject  three  or  four 
daily.     Useful  for  the  suppression  of  fetor.     (Sn.) 

9:.    Zinc.  Sulphatis, 

■   Alum.  Sulphatis,  aa  .^iss. 

Glycerini,  ^vj. 

M. 

Sig.     A  tablespoonful  to  a  quart  of  hot  water  for  injection. 
(Sn.) 

The  folio-wing  suppository  may  occasionally  be  of 
service : 

9.    Pulv.  Catechu,, 

Aluminis,  aa  3J. 

Ol.  Theobronicfc,  q.  s. 

M.     Ft.  Suppos.,  No.  vj. 
Sig.     One  night  and  morning.  (Sn.) 

The  following  douches  are  to  be  emplo^^ed  for  anti- 
sepsis : 

Hydrarg.  Bichlorid.,  1-4000  or  2000,  for  occa- 
sional use. 

Carbolic  Acid,  1-100  or  1-200. 

Izal,  3j-0j. 

Condy's  Fluid,  Sulpho-Carbolate  of  Soda,  Creolin, 
Lysol,  each  in  the  proportion  of  1-200. 

Liq.  Sodii  Chlorinatse,  5J-0j. 

Potass.  Permang.,  gr.  xx— Oj  ;  inject  a  small  quan- 
titj^  three  times  a  day  as  a  deodorant  when  dis- 
charge is  ver\'  offensive.     (Alb.) 

When  sedative  douches  are  desired,  the  following 
may  be  employed : 

Liq.  Plumbi  Subacetatis,  ^ij-Oiij. 

Liq.  Opii  Sedativusi,  3J-0j. 

Chloral  Hydras,  gr.  xx-Oj. 

Sodii  Boras  or  Sodii  Bicarbonas.,  giij-Oj.     (Alb.) 


LICHEN  RUBER.  371 


LICHEN  RUBER. 

Simple  ointments,  such  as  Cold  Cream  or  Vase- 
line, w^hen  there  is  no  itching. 

Tar  Ointment: — Indicated  in  various  forms,  but 
must  be  used  with  discretion,  as  it  does  not  always 
agree.  Oil  of  Cade  in  an  ointment  containing  1  to 
3  drachms  to  the  ounce,  or  diluted  w^ith  an  equal 
quantit^^  of  olive  oil  or  cosmoline,  is  beneficial. 
(B.  H.) 

Liq.  Carbonis  Detergens: — Preferred  by  Crocker  as 
a  lotion  in  the  strength  of  10  minims  to  1  drachm  to 
the  ounce  of  water. 

Liq.  Picis  Alkalinus  : — Made  in  the  foUow^ing  man- 
ner: 

Jfc.    Potass.  Causticse,  gr.  xv. 

Picis  Liquidse,  gr.  xxx. 

Aquae,  |iv. 
M. 

This  should  be  considerably  diluted  when  first 
used,  as  it  is  irritating.     (Vn.) 

Naphthol  or  Thymol: — Gr.  x— 3ij,  w^ith  vaseline  §j, 
recommended  by  Crocker ;  useful  for  the  itching. 

Unna  keeps  the  patient  in  bed  between  blankets, 
and  has  him  rubbed  night  and  morning  w^ith  this 
ointment : 

9;.    Ung.  Zinc.  Oxid.  Benzoatis,  ^iv. 

Acid.  Carbolici,  Qiv. 

Hydrarg.  Bichlorid.,  gr.  ij-iv. 
M.  (Ja.) 


372  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

In  chronic  cases  Hardaway  uses  the  following,  well 
rubbed  in  with  flannel : 


Sapo.  OlividK  Praeparatse, 

Siv. 

Ol.  Rusci, 

Glycerini, 

aa  Ei- 

Ol.  Rosmarini, 

3iss. 

Alcohol  is, 

ad  ^viij 

M. 

Hot  Compresses  once  or  twice  daily  will  often  re- 
lieve severe  cases ;  Emollient  and  Alkaline  Baths  are 
useful  in  cases  when  the  skin  is  very  irritable. 

The  following  was  recommended  by  Unna : 


T^.    Hydrarg.  Bichlorid., 

gr-  vij 

Cretse  Praeparatse, 

3iiss. 

Acid.  Carbolici, 

Ol.  Olivae, 

aa  ^y. 

Uiig.  Zinc.  Oxidi, 

^xv. 

M. 

Sig.     Rub  in  thoroughly. 

(Sn.) 

Salicylic  Acid: — Gr.  x— xx  to  alcohol  and  water  3J, 
or  in  an  ointment  gr.  x— xx— §j ;  a  10  to  20  per  cent, 
plaster  is  effective  in  thickened  verrucous  patches. 
(B.H.) 

Menthol: — Indicated  especially  when  itching  is  a 
prominent  symptom ;  use  in  an  ointment,  gr.  x— xv— 
Ij.    (B.H.) 

In  addition  to  the  above,  the  more  stimulating 
and  stronger  antipruritic  remedies  which  have  been 
mentioned  for  eczema  may  be  employed  for  this  affec- 
tion, with  the  view  of  relieving  the  pruritus  and 
causing  absorption  of  the  lesions. 


LOCOMOTOR  ATAXIA.  373 


LOCOMOTOR  ATAXIA. 

Fraenkel's  Exercise  Treatment: — This  method,  it  is 
claimed,  is  exceedingly  helpful  in  keeping  patients  on 
their  feet  for  years,  and  benefiting  those  who  have 
not  walked  for  a  long  period  to  such  a  degree  that 
the  powers  of  locomotion  are  restored  sufficiently  for 
the  patient  to  walk  about.  There  are  two  classes  of 
exercises,  those  performed  in  bed  and  those  performed 
out.  The  bed  exercises  consist  of  flexion,  extension, 
abduction,  and  adduction  of  each  leg  separately, 
then  both  simultaneously.  The  knees  and  hips  are 
likewise  exercised.  The  patient  is  asked  to  place  the 
heel  of  one  foot  upon  the  big  toe  of  the  other,  then 
place  the  heel  upon  the  knee  of  the  other  leg,  then 
slowly  travel  upon  the  ridge  of  the  tibia  to  the  ankle. 
These  exercises  are  made  alternately,  first  with  one 
leg  then  with  the  other,  with  the  eyes  open  and  then 
with  the  eyes  closed,  and  should  be  attempted  over 
and  over  again,  morning  and  afternoon,  for  half  an 
hour  at  a  time  with  frequent  rests ;  the  patient 
should  be  encouraged  to  persist  until  he  succeeds. 

The  exercises  performed  out  of  bed  are  as  follows : 

1.  Place  the  patient  with  back  to  a  chair,  heels  to- 
gether ;  let  him  seat  himself  slowly  in  the  chair,  then 
let  him  rise  in  the  same  careful  manner.  No  cane  is 
used ;  if  he  cannot  stand  attendants  on  each  side 
must  support  him. 

2.  Let  one  leg  be  placed  at  a  walking  step  in  front 
of  the  other,  then  placed  back  into  the  original  posi- 
tion vt^ith  great  exactness.  Repeat  the  same  with 
the  other  leg.  Patient  may  support  himself  if  neces- 
sary. 


374  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

3.  Walk  three  paces  slowly  and  with  precision. 

4.  Rest  in  standing  position  with  one  foot  before 
the  other  AA^ith  arms  akimbo;  flex  the  knees  then 
slowly  rise. 

5.  Patient  exercises  as  in  No.  2 ;  advances  one  foot, 
then  return  it  slowly  to  original  position,  then  walks 
one  step  behind  the  other.  This  is  very  difficult,  as 
it  requires  a  great  deal  of  balancing  power. 

6.  Walk  twenty  steps,  as  in  No.  3. 

7.  No.  2  performed  with  a  cane. 

8.  Stand  with  a  cane  w^ith  feet  together  and  haftds 
on  the  hips. 

.  9.  Stand  without  cane,  feet  separated,  and  make 
various  movements  with  the  arms,  grasping  objects 
or  forcing  back  outstretched  hand  of  attendant. 

10.  Maintain  same  position  as  in  No.  9 ;  then  flex 
the  trunk  forward  and  back,  right  and  left. 

11.  No.  9,  w^ith  feet  together. 

12.  No.  10,  with  feet  together. 

13.  Walk  along  a  parallel  line  in  the  floor,  patient 
supporting  himself  with  a  cane. 

14.  Same  as  No.  13,  without  a  cane. 

Exercises  with  fingers  and  arms  are  recommended, 
based  on  the  same  principles.     (Gld.) 

Sodium  Phosphate : — A  hypodermic  injection  of  a 
0.1  per  cent,  solution  has  recently  been  used  for  the 
relief  of  the  darting  pains,  w^hich  it  is  claimed  to 
have  considerabl J'- diminished.     (T.,  98.) 

Theine:^Has  proved  serviceable  in  relieving  the 
pains,  large  doses  hj^podermically ;  as  much  as  3 
grains  are  said  to  have  been  given.     (F.) 

Electricity: — In  the  treatment  of  this  affection  this 
is  an  agent  in  reference  to  w^hich  there  is  a  marked 
divergence  of  opinion.    It  is  condemned  hj  some  and 


LOCOMOTOR   ATAXIA.  375 

praised  by  others ;  in  German^^  it  is  much  used,  but 
does  not  appear  to  be  so  extensively  endorsed  in  this 
countr3^  It  is  claimed  that  if  administered  early  in 
the  course  of  the  disease  electricity  is  capable  of  ar- 
resting the  morbid  process,  but  if  cases  are  not 
properly  selected  it  will  do  harm.     ( Ht. ) 

Erb's  combined  galvanism  of  the  spinal  cord  and 
sympathetic  cervical  ganglion  constitutes  the  best 
central  application.  The  negative  pole  is  placed  over 
the  superior  cervical  ganglion  on  one  side,  w^hile  the 
positive  is  applied  to  the  lumbar  region  of  the  spine 
on  the  opposite  side  of  the  spinous  processes.  A  cur- 
rent of  6  to  8  milliamperes  is  passed  for  one  minute 
and  a  half.  Then  the  electrodes  are  changed  to  the 
opposite  sides,  that  is,  the  negative  electrode  is 
placed  where  the  positive  was  applied  and  the  pos- 
itive to  w^here  the  negative  has  been.  The  current  is 
again  allowed  to  pass  through  the  parts  one  minute 
and  a  half.  The  negative  electrode  is  now  placed 
over  the  spinous  processes  of  the  cervical  vertebrae 
and  the  positive  over  those  of  the  lumbar.  After  this 
the  limbs  and  trunk  are  treated  thoroughly  with  the 
faradic  brush,  with  a  current  as  strong  as  can  be 
borne  without  inconvenience.  Applications  may  be 
made  on  alternate  days.     (Gn.) 

Static  electricity  is  also  employed  with  great  relief 
in  some  cases.     (F.) 

Hydrotherapy: — Is  a  serviceable  measure  if  used 
judiciously.  Tepid  baths  (80°  to  90°)  combined  with 
gentle  rubbing  are  beneficial.  Hot  and  wet  packs 
and  vapor  baths  are  used,  but  are  claimed  by  some 
authorities  to  be  harmful.  Wet  compresses  on  the 
legs  at  night  will  sometimes  relieve  pain.     (Ty.) 

Among  the  natural  springs  which  enjoy  an  especial 


376         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

reputation  for  treatment  of  this  disease  are  Oeyn- 
hausen-Rehme  in  Minden,  Aix-la-Chapelle  and  Nau- 
heim.  The  mud  and  iron  baths  of  Pyrmont,  Driburg, 
Elster,  Carlsbad,  and  Franzenbad  may  also  be  men- 
tioned in  this  conection. 

Massage: — By  its  general  effect  upon  the  nutri- 
tion and  circulation,  may  from  time  to  time  be  em- 
ployed with  benefit.  Disturbancee  of  sensibility  often 
improve  under  this  treatment.     (F.) 

Bonuzzi's  Treatment: — This  is  described  bj^  P.  J. 
Mobuis,  of  Leipsic,  as  "actually  barbarous."  It  con- 
sists in  drawing  the  feet  of  the  patient,  by  means 
of  a  cloth,  so  far  above  his  head  that  the  knees 
approach  the  forehead.  Blondell's  modification  of 
this  treatment  consists  in  an  extension  en  miniature^ 
approximating  the  patient's  bended  knees  to  his 
chin,  and  holding  them  in  that  position  for  a  few 
moments  by  means  of  a  bandage  passing  behind  the 
knees  and  about  the  neck.     (T.  C,  Vol.  XI.) 

Suspension : — By  means  of  Sayre's  apparatus,  first 
tried  by  Motschutkowsky,  of  Odessa,  was  much  in 
vogue  at  one  time,  but  this  procedure  is  attended 
with  some  danger,  especially  in  heavy  patients,  and 
those  w^ith  arterio-sclerosis.  Its  results  have  not 
proved  as  satisfactory  as  they  promised,  and  like 
many  other  "cures "  it  has  fallen  into  disuse.  (T.  C, 
Vol.  XI.) 

Mercurial  Inunctions: — Advised  in  syphilitic  cases 
and  those  in  which  there  is  a  suspicion  of  specific 
taint ;  3  to  4  grains  of  blue  ointment  daily  may  be 
rubbed  in,  and  a  bath  should  be  taken  on  the  seventh 
day;  this  procedure  may  be  repeated  four  or  five 
times.  The  gums  should  be  watched  carefully.  After 
an  interval  of  five  or  six  weeks  or  several  months  a 


LUPUS  ERYTHEMATOSUS.  377 

second  course  may  be  administered.  The  baths  of 
Nauheim  and  Rehme  are  advised  by  Erb  during  the 
intervals  of  inunctions.     (T.  C,  Vol.  XI.) 


LUPUS  ERYTHEMATOSUS. 

While  in  external  treatment  we  look  for  positive 
effect,  it  should  be  remembered  that  the  disease  some- 
times disappears  spontaneously,  v^rith  little  or  no 
scarring;  therefore,  applications  which  have  a  ten- 
dency to  disfigure  should  be  avoided. 

Sapo  Viridis: — This  remedy  has  been  recommended 
by  Hebra  and  Kaposi,  and  is  at  times  very  useful ;  it 
may  be  used  pure  or  diluted  in  the  proportion  of  two 
parts  with  one  of  alcohol  (spts.  sapo.  kal.);  this  is 
to  be  rubbed  in  energetically  once  or  twice  daily. 
The  sapo  viridis  plaster  maj--  be  used  when  a  more 
active  method  is  desired.  After  several  days  the 
soap  is  to  be  discontinued  and  a  soothing  ointment 
applied.  The  spts.  sapo.  kal.  may  also  be  employed 
with  advantage  to  cleanse  the  parts  preparatory  to 
the  application  of  other  remedial  agents.     (Pp.) 

Carbolic  Acid : — Applied  pure,  forms  one  of  the  best 
applications .     ( Kp . ) 

Ichthyol: — Useful  in  the  following  formula  sug- 
gested by  Unna : 

Ifc. .  Ichthyoli,  9iv. 

Amyli,  Qiv. 

Sol.  Albumin.  Concentrat.,  M.v-viij. 

Aquae,  ad  ^j. 
M. 

This  preparation  dries  quickly,  and  a  new  coat 
may  be  added. 


378  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Glacial  Acetic  Acid: — A  mixture  of  equal  parts 
with  glj'cerine  has  been  found  serviceable  in  small 
patches  and  seemed  to  stimulate  absorption  of  de- 
posits.    (Pp.) 

Zinc  Nitrate: — In  severe  and  chronic  cases  the  fol- 
lowing was  recommended  by  Tilbury  Fox : 

9?.    Zinc.  Nitratis,  Siss. 

Aq.  Destill., 
Amyli  Glyceriti, 

Farini  Tritici,  aa  33. 

M. 
Make  into  a  paste  and  apply;  when  the  paste  is  withdrawn,  apply 
a  poultice;  the  raw  surface  left  by  removal  of  the  eschar  should  be 
dusted   with   diachylon   or   zinc  oxide    ointment.     Reapplication 
may  be  needed.     ( F. ) 

Alcohol: — Hebra  has  treated  several  cases  bj^  the 
application  of  alcohol  with  remarkably  good  results. 
In  an  acute  case  the  eruption,  w^hich  had  spread 
steadih^  downwards  as  far  as  the  lower  edge  of  the 
manubrium,  disappeared  completely  after  a  treat- 
ment of  four  weeks,  and  there  was  no  trace  of  it  six 
months  later.  Chronic  cases  were  cured  or  at  least 
benefited.  The  method  is  simply  to  moisten — not  to 
rub — the  patches  with  a  pad  of  cotton-wool  soaked 
in  alcohol.  The  more  often  this  is  is  done  the  sooner 
the  effect  appears.  To  increase  the  antiphlogistic 
effect  in  his  last  cases,  Hebra  has  used  the  following : 

9?.  Alcoholis  Absoluti, 
.i^theris  Sulphurici, 
Spts.  Menthae  Pip.,  partes  equales. 

It  is  important  to  avoid  the  use  of  soap  during 
treatment.     (M.  S.  R.  R.,  5,  1,  99.) 

Pyrogallic  Acid: — Is  serviceable  when  strong  reme- 
dies are  necessary- ;  being  somewhat  caustic  in  action 


LUPUS  ERYTHEMATOSUS.  379 

it  must  be  watched;  it  may  be  employed  in  the 
strength  of  40  to  90  grains  to  the  ounce  as  an  oint- 
ment ;  weaker  appHcations  should  be  tried  first.  It 
is  safer  and  more  satisfactory  w-hen  applied  in  flex- 
ible collodion,  as  follows : 

9;.    Acid.  Pj-rogallici,  5J' 

Liq.  Guttge  Perchge,  5^^- 

M. 

Sig.  Apply  with  a  brush  on  patches  several  times  until  con- 
siderable reaction  takes  place  or  a  crust  forms,  then  dis- 
continue. As  soon  as  the  crust  is  removed,  repeat  the 
application;  if  there  is  much  scaling,  30  grains  of  sali- 
cylic acid  may  be  added.     (Pp.) 

Naphthol  Sulphur  Soap: — Excellent  for  cleansing. 
(Kap.) 

The  following  lotion  is  recommended  when  inflam- 
matory symptoms  are  marked,  and  in  recent  and 
superficial  forms  with  little  infiltration  and  no  in- 
volvement of  the  sebaceous  glands : 

9^.    Zinc.  Sulphatis, 

Potass.  Sulphureti,  aa  3ss. 

Aquae,  giij. 

Alcoholis,  5j- 

M. 
The  salts  should  be  dissolved  separately  in  water,  and  the  lotion 
added.    The  parts  are  to  be  mopped  twice  daily  for  fifteen  to  thirty 
minutes;  if  too  strong,  dilute.     (Pp.) 

Chrysarobin  : — A  stronger  application,  suitable  for 
cases  mentioned  in  the  preceding  paragraph,  as  well 
as  when  there  is  more  infiltration,  is  as  follows : 

9;.    Chrysarobini,  3^* 

Acid.  Salicylici, 

Pulv.  Calaminae,  aa  3ss. 

^^theris,  3j- 

Collodii  Flex. ,  5v. 

M.  (Vn.) 


380  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

An  ointment  of  40  to  90  grains  to  the  ounce  may- 
be used  in  place  of  p^^rogallic  acid  with  the  same  in- 
dications. It  is  dangerous  for  use  about  the  face,  as 
it  may  cause  violent  conjunctivitis.     (Pp.) 

Pyoktanin: — Daily  application  of  a  saturated  solu- 
tion, is  of  great  value  in  torpid  cases.  Naphthol  and 
Sulphur  pastes  promoting  desquamation  are  useful 
in  the  same  conditions.     (T.,  98.) 

Caustics : — These  are  somtimes  demanded,  but 
w^eaker  applications  should  always  be  tried  first. 

Caustic  Potash: — 1  part  to  3  to  6  water,  applied  by 
means  of  a  charpie  brush  on  a  stick,  forms  one  of 
the  best  caustics.     ( Vn. ) 

Linear  Scarification: — Used  in  cases  w^hich  are  ex- 
tensive and  much  infiltrated ;  better  than  caustics 
and  strong  applications.  Use  a  fine  scalpel  or  teno- 
tome or  multiple  scarifier,  holding  it  in  the  hand  like 
a  pen.  Make  a  series  of  parallel  incisions,  about  one- 
sixteenth  of  an  inch  apart,  and  extending  entirely- 
through  the  skin;  having  covered  the  part  v^ath 
these  parallel  incisions,  make  another  series  at  right 
angles,  and  even  a  third  obliquely  maj-  be  made; 
successive  patches  of  an  inch  square  ma^^  be  operated 
upon  daily.  The  wounds  maj-  be  dressed  with  an  an- 
tiseptic powder,' such  as  aristol  or  europhen.  Little 
scar  is  left,  and  the  result  is  more  satisfactory  than 
any  other  method  of  treatment.  The  skin  must  be 
frozen  bv  ether  or  salt  and  ice  before  operation. 
(Ck.) 

Erasion  by  Curette  and  Scraping  Spoon  has  been 
used  in  severe  cases,  but  scarification  is  better. 

Paquelin  Cautery: — Heat  barely  red  and  run  over 
the  surface  very  superficially,  then  dress  with  iodo- 


LUPUS  VULGARIS.  381 

form  which  forms  a  crust.  After  about  ten  days  this 
falls  off  leaving  a  smooth  pale  surface.     (Vn.) 

Electrolysis: — Multiple  puncture  will  sometimes 
give  brilliant  results.     (Ja.) 

Tr.  Iodine: — Alone  or  with  equal  parts  of  glycerine, 
painted  on  once  or  twice  daily  until  a  coating  forms, 
is  sometimes  used,  or  it  may  be  applied  as  follows : 

^.    lodi, 

Potass.  lodidi,  aa  3iv. 

Glycerini,  -  gj. 

M.  (Pp.) 

Oil  of  Cade  : — With  alcohol  and  green  soap,  equal 
parts ;  rub  in  night  and  morning.     (Pp.) 

Oleate  of  Mercury: — 10  to  25  per  cent,  ointment 
rubbed  in  daily  is  of  value.     (Pp.) 

Plasters  of  Resorcin,  Ichthyol,  Hydronaphthol, 
and  Mercury  are  effective,  the  latter  is  especially 
recommended  by  Kaposi. 


LUPUS     VULGARIS-TUBERCULOSIS 
CUTIS. 

External  measures  are  absolutely  essential  in  all 
cases.  In  the  early  stages  stimulating  applications 
used  w^ith  a  view  of  causing  absorption  are  unsuc- 
cessful, and  severer  methods  w^ill  have  to  be  em- 
ployed. Mild  applications,  such  as  oils,  ointments 
and  plasters,  namely,  olive  oil,  soft  soap,  simple 
ointment,  salicylic  and  mercurial  plaster,  will  often 
form  useful  adjuvants  in  reducing  swelling  and  in- 
flammation, macerating  crusts  and  promoting  the 
formation  of  smooth  cicatrices. 


382  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Local  treatment  is  either  by  operative  procedures 
or  b^^  the  apphcation  of  caustics. 

Erasion  by  Volkmann's  Spoon: — This  is  the  fore- 
most surgical  method,  though  not  complete,  inas- 
much as  small  nodules  may  be  left,  which  must  be 
removed  by  other  means.  It  is  well  adapted  to  large 
confluent  nodules,  with  flabby  base  and  depressed 
infiltrated  tissue.     (Kap.) 

Curettage: — The  whole  patch  or  patches  may  be 
scraped  w^ith  the  dermal  curette,  then  Pyrogallic 
Ointment,  25  to  30  per  cent.,  should  be  applied  for 
ten  days,  and  that  in  turn  followed  by  Mercurial 
Plaster.  The  acid  will  cause  free  suppuration  and 
destroy  the  cells  left  by  the  curette.  A  second  or 
third  application  may  be  necessary.  Individual  nod- 
ules may  be  bored  out  with  Morris's  double  screw 
instrument,  or  with  Fox's  dental  burrs  and  hooks, 
then  pure  Carbolic  Acid  is  applied  to  the  little  ex- 
cavation thus  produced.     (Ja.) 

Galvano-Cautery: — Has  the  disadvantage  of  burn- 
ing healthy  as  well  as  diseased  tissue ;  it  is,  however, 
serviceable  in  destroying  recurrent  nodules  and  those 
situated  on  the  mucous  membranes.  (B.  H.)  It  is 
preferred  by  some  dermatologists  for  application 
after  curettage. 

Linear  Scarification: — Another  valuable  measure 
and  efiective  in  non-ulcerative  forms.  The  parts  are 
thoroughly  cross-tracked,  according  to  Vidal's 
method;  if  bleeding  is  profuse,  cold  or  hot  com- 
presses should  be  applied.  A  five-bladed  lancet,  con- 
structed for  the  purpose,  may  be  used  for  making  the 
incisions.  After  scarification  a  caustic  is  applied,  fol- 
lowed by  antiseptic  dressings.  The  operation  may 
have  to  be  repeated. 


LUPUS  VULGARIS.  383 

Besnier's  Method:  —  Employed  with  advantage. 
This  consists  in  the  use  of  electro-cautery  knives  of 
various  shapes  and  sizes,  applied  veith  a  view  of 
reaching  all  varieties  of  deposits.     (Vn.) 

Multiple  Punctate  Scarification: — Also  advised. 
Veiel's  instrument  or  Pick's  multiple  scarificator 
maj^  be  used.  The  knives  before  use  may  be  dipped 
in  iodine,  carbolic,  or  some  other  antiseptic.  This 
procedure  is  of  service  especially  for  hypertrophic 
conditions ;  also  for  the  In^pertrophic  scars  which 
sometimes  result  from  erosion.     (B.  H.) 

The  scars  which  follow  the  use  of  the  curette,  and 
linear  and  punctate  scarification  are  usually  less 
marked  than  those  which  result  from  the  cauterants. 

(Pp.) 
Excision  and  Grafting  after  Thiersch's  Method: — 

Excision  is  available  for  patches  of  any  size.  Both 
the  lupoid  patch  and  the  part  from  which  the  grafts 
are  to  be  cut  (preferably  the  thigh)  should  be  thor- 
oughly disinfected  with  soap  and  water,  ether  and 
carbolic  acid  the  day  before  operation,  and  a  pack  of 
gauze  soaked  in  a  solution  of  carbolic  acid,  1-20, 
should  be  kept  on  the  surface  until  the  operation. 
The  foUow^ing  points  may  be  mentioned : 

1.  The  parts  are  thoroughly  cleansed  and  every 
precaution  subsequently  taken  by  the  operator  to 
prevent  infection  by  the  knife. 

2.  Before  operating  a  line  of  incision  is  marked  out 
beyond  the  disease  by  means  of  sterilized  aniline  dye. 

3.  Haemorrhage  is  carefully  arrested  before  grafts 
are  applied. 

4.  Dress  the  surface  with  simple  layers  of  dry 
sterile  gauze  fastened  with  collodion,  and  allow  the 
dressing  to  remain  four  or  five  days ;  a  second  dress- 


384  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

ing  should  be  applied  similar  to  the  first,  then  a 
dermatol  or  iodoform  ointment. 

5.  Certain  cases  are  unsuitable  b3^  reason  of  impli- 
cation of  the  nasal  cavity,  multiplicity^  of  areas,  or 
the  extent  of  the  disease.  Tv^^o  or  three  sittings,  at 
intervals,  may  be  emploved  -with  extensive  cases. 
(T.,  98.) 

Caustics  .• — Though  surgical  procedures  have 
largely  superseded  the  use  of  caustics,  they  are  none 
the  less  of  service ;  yet  it  must  be  remembered  that 
certain  of  these  agents,  namely,  Vienna  paste,  zinc 
chloride  (the  pure  stick  or  Canquin's  paste),  lactic 
acid,  and  salicylic  acid  produce  most  unsightly  scars. 
(B.  H.) 

Caustic  Potash : — When  thorough  and  extensive 
destruction  of  tissue  is  desired  a  stick  wrapped  in  a 
cloth  with  the  point  protruding,  should  be  forced 
down  into  the  diseased  foci ;  the  effect  of  the  caustic 
goes  beyond  the  point  touched;  dilute  vinegar 
should  be  kept  near  at  hand  to  check  and  neutralize 
its  action  and  relieve  the  severe  pain.     (Vn.) 

Nitrate  of  Silver : — Is  effective  in  some  cases,  and 
as  it  leaves  no  scars  maA^  be  selected  to  use  on  the 
face ;  its  action,  however,  is  superficial.  Papules  and 
tubercles  may  be  destroyed  by  boring  with  the  solid 
stick,  and  patches  may  be  mopped  with  a  saturated 
solution.     (Ck.) 

Liq.  Antimonii  Chlorati: — Regarded  bj-  Unna  as 
superior  to  any  other  remedy.  He  emploj^s  it  in  two 
forms,  and  recommends  the  addition  of  salicylic 
acid,  creosote,  and  cannabis  indica. 

For  ordinarv  cases : 


LUPUS  VULGARIS.  385 

9^.     Acid.  Salicylici, 

L,iq.  Antimonir  Chlorati, 

Ext.  Cannabis  Indicse,  aa  gr.  xvss. 

Creosoti  Fagi,  gr.  xxxj. 

Vaselini,  Sig*"-  xviiss. 

Adipis  Lanse,  3"&^-  xxxv. 

M. 

This  is  applied  to  all  the  nodules  with  a  glass  rod,  and  the  whole 
lupus  region  is  covered  with  a  zinc  oxide  plaster.  The  covering 
intensifies  the  action  of  the  ointment  and  protects  the  surrounding 
parts. 

In  older  cases,  with  scattered  nodules  and  deep 
forms  of  the  disease,  a  stronger  ointment  may  be 
used,  viz.: 

9;.    Acid.  Salicylici, 

Liq.  Antimonii  Chlorati, 

Ext.  Cannabis  Indicae, 

Creosoti  Fagi, 

Vaselini,  aa  gr.  xxxj. 

Adipis  Lanae,  5"S''-  xxxv. 

M. 

The  dressings  are  changed  every  day  or  every  second 
day,  according  to  the  amount  of  suppuration.  After 
some  weeks  of  this  treatment  the  nodules  ulcerate 
and  then  begin  to  heal  over,  often  without  further 
treatment,  leaving  a  smooth  surface.  In  obstinate 
cases,  when  the  dressing  is  changed,  the  liquor  anti- 
monii chlorati  may  be  applied  to  doubful  spots. 
Cocaine  may  be  previously  applied.     (T.,  97.) 

Salicylic  Acid  and  Creosote  : — 1  part  of  the  acid 
with  2  parts  of  creosote,  made  into  a  plaster,  was 
regarded  bj^  Unna  as  the  best  superficial  caustic 
until  his  adoption  of  the  preparation  of  chloride  of 
antimony  as  above.     (T.,  97.) 

Hydrarg.    Bichlorid.: — Unna  recommends  the  fol- 
lowing : 
26 


386  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

5fc.    Hydrarg.  Bichlorid.,  gr.  iij. 

Acid.  Carbolici,  •  gr.  xij. 

Alcoholis,  3J- 

M. 
A  small  sharpened  stick  is  dipped  into  this  solution  and  bored 
into  each  little  lupus  deposit.     The  pain  does  not  last  long. 

Pyrogallic  Acid: — Is  one  of  the  best  remedies ;  an 
ointment  of  a  drachm  to  the  ounce  of  vasehne, 
spread  on  cloth  and  renewed  twice  daih%  is  painless 
and  efficient  in  many  instances ;  it  appears  to  select 
the  diseased  tissues  and  acts  but  little  on  the 
healthy.     (N.) 

A  combination  with  Aristol  is  used,  vi2.: 

1^.    Pyrogalloli,  gr.  ix. 

Aristoli.  gr.  xviij. 

Lanolini, 

Vaselini,  aa  5SS. 

M.  (T.,  97.^ 

Zinc  Chloride  : — According  to  the  following  for- 
mula: 

p.    Zinc.  Chloridi, 

Antimonii  Terchloridi,  aa  3ij- 

Acid.  Hydrochlorici,  q.  s. 

Enough  acid  is  added  to  dissolve  the  zinc,  and  the  mixture  is 
rubbed  up  in  a  mortar  with  sufficient  powdered  licorice  to  make  a 
paste.  This  forms  a  powerful  caustic,  but  it  is  very  painful  and  eats 
through  both  healthy  and  diseased  tissues.     (Vn. ) 

Ethylate  of  Sodium  : — Applied  on  glass  rods ;  the 
part  should  be  first  dried  as  far  as  possible,  and  no 
water  allowed  to  touch  it  while  the  application  is 
being  made.  This  agent  is  less  painful  than  other 
caustic,  and  may  be  preferred  in  minor  operations 
when  an  anaesthetic  is  not  used.     (N.) 

Cosme's  Paste: — As  modified  by  Hebra  is  as  fol- 
lows: 


LUPUS  VULGARIS.  387 

9;.    Acid.  Arsenosi,  gr.  x. 

Hydrarg.  Sulphuret.  Rub.,  5J- 

Ung.  Simplicis,  5J. 

Spread  on  lint  or  linen  and  apply  firmly;  leave  it  on  for  two  or 
three  days;  poultices  are  then  applied  until  the  slough  comes  away; 
then  mild  stimulating  ointments. 

This  method  is  very  satisfactory  but  very  painful. 

Lactic  Acid  : — Has  given  beneficial  results ;  the 
pure  acid  is  made  into  a  paste  with  salicylic  acid ; 
the  lint  saturated  with  the  remedy  or  covered  with  a 
thin  layer  of  the  paste  should  be  applied;  the  sur- 
rounding health3''  tissue  must  be  protected  by  gutta 
percha  solution.  After  twentj^-four  hours  remove 
and  dust  with  iodoform  gauze.     (Al.) 

At  Unna's  clinic,  pointed  matches  are  soaked  in  the 
following  solution : 

Sublimate,  i  part. 

Salicylic  Acid,  lo  parts. 

Ether,  25  parts. 

Olive  Oil,  100  parts. 

These  are  bored  into  each  individual  nodule,  the  ends  cut  off 
with  scissors  and  left  /«  situ;  then  covered  with  mercury  carbolic 
plaster;  after  twenty-four  hours  this  is  removed,  the  part  washed 
and  the  holes  filled  with  the  following  powder: 

Sublimate,  gr.  iss. 

Cocaine,  gr.  viij. 

Salicylic  Acid,  gr.  viij. 

Magnesium  Carbonate,  5ij  9ij- 

(T.,96.) 

For  other  caustic  applications  see  Epithelioma. 

Aristol: — Has  been  found  effective  after  curettage. 

Ethyl-Diamine  Cresol: — Has  been  favorably  men- 
tioned ;  it  is  a  colorless,  nearH^  non-toxic  liquid,  with 
remarkable  penetrating  power,  and  a  stronger  disin- 
fectant than  cresol.  Solutions  of  1-5000  to  3000  on 
compresses  have  been  found  healing  in  lupus  of  the 


388  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

face.    Continuous  baths  have  been  used  for  the  dis- 
ease on  the  limbs.     (T.,  98.) 

Guaiacol  and  Thymol: — Have  been  successful  sub- 
cutaneously.  Injections  of  15  minims  of  the  follow- 
ing tv^ace  a  w^eek : 

Thymol,  Yz  drachm. 

Guaiacol  (Sterilized), 

Olive  Oil,  each,  \%  drachms. 

Great  caution  is  necessary,  as  severe  pulmonary 
congestion  is  apt  to  occur.     (T.,  96.) 

Salicylic  Acid: — In  addition  to  combination  v^ith 
other  remedies  as  already  mentioned,  is  used  in  other 
forms ;  a  10  to  20  per  cent,  plaster,  changed  once  or 
twice  a  day ;  a  saturated  solution  in  collodion,  said 
to  be  efficacious  after  cleansing  the  parts  with  an 
alkaline  solution;  or  an  ointment  5J-ij-SJ,  as  a  mild 
•and  slow  acting  remedy. 

Picric  Acid: — Thoroughly  dusted  on  the  parts,  fol- 
lowed in  a  few  days  by  1  to  20  per  cent,  ointment, 
constitutes  another  method  \vhich  has  been  reported 
successful.     (T.,  96.) 

Mono-Chlorophenol: — 20  per  cent,  solution  in  alco- 
hol rubbed  in  rather  hard  w^ith  a  pad  of  wadding 
every  two  daj^s  for  several  months  has  been  tried 
with  encouraging  results.     (T.,  98.) 

Injections  of  Calomel  and  of  Camphorated  Naph- 
thol  have  also  been  recentlj^  emplo3'ed.     (T.,  98.) 

Meragliano's  Serum:  —  Two  cases  have  been  re- 
ported as  successfully  treated ;  doses  of  16  and  80 
minims  alternately,  the  part  being  painted  with  the 
serum.     (T.,  97.) 

Tuberculin: — Hopes  that  have  been  raised  in  re- 
gard to  the  use  of  this  remedy  have  been  proved  to 
lack  foundation,  as  the  disease  was  found  to  recur 


LUPUS  VULGARIS.  389 

after  the  injections  had  been  discontinued,  in  some 
cases  with  increased  virulence. 

Koch,  after  nearlj^  five  A^ears'  silence,  has  an- 
nounced three  new  modifications  of  tuberculin,  in- 
cluding that  of  tuberculin  R.  wdth  immunizing  and 
curative  properties,  which  has  led  to  marked  im- 
provement by  injection  in  lupis  vulgaris.  Koch's 
directions  were  to  commence  with  a  small  dose  (one 
five- hundredth  of  a  milligramme),  which  is  raised  as 
rapidily  as  possibly,  caution  being  exercised  not  to 
excite  constitutional  reaction  and  not  to  administer 
a  second  dose  until  the  temperature  has  fallen  to 
normal  or  nearly  so.  The  cure  is  completed  when  a 
twent3^  milligramme  dose  is  reached. 

The  remedy  has  also  been  employed  by  Bussenius, 
Womer,  Seligmann,  Malcolm,  Morris,  Whitfield, 
Lassar,  Doutrelepont,  and  Van  Horn  with  generally 
favorable  results,  but  judging  from  the  reports  there 
were  no  decided  cures.  Doutrelepont  recommends 
that  the  dose  be  increased  more  slowly  than  sug- 
gested by  Koch.  In  brief,  it  may  be  said  that  the 
use  of  tuberculin  for  tuberculosis  of  the  skin  has 
scarcely  j^et  gone  beyond  the  stage  of  experimenta- 
tion. The  preparations,  moreover,  are  not  of  uniform 
strength  and  may  sometimes  cause  unfavorable 
symptoms.  The  difficulty  of  obtaining  it  and  the 
price  are  additional  drawbacks  to  its  practical  use. 

Phototherapy :  —  Finsen,  of  Copenhagen,  who  is 
known  as  the  reviver  of  the  mediccval  red  light  treat- 
ment for  smallpox,  has  reported  very  satisfactory 
results  from  the  use  of  the  electric  light  in  the 
treatment  of  lupus  vulgaris.  Dr.  Valdemar  Bie,  Fin- 
sen's  chief  assistant,  in  a  recent  article  says,  350 
cases  of  this  disease  have  been  successfully  treated  by 


390  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

this  method.  The  less  severe  cases  were  treated  by 
light  alone,  those  of  a  more  serious  nature  received 
the  light  treatment  in  conjunction  with  pyrogallic 
acid  ointment  to  make  the  skin,  it  is  said,  smooth 
and  easily  penetrable  by  the  light.  While  one  part 
w^as  being  treated  by  the  light  the  pyrogallic  acid 
was  applied  on  the  other.  When  cauterization  was 
healed  by  zinc  ointment  this  area  of  skin  was  treated 
by  light.  All  ulcerations  are  kept  free  from  crusts  by 
cataplasms  of  boric  acid  solutions.  The  mucous 
membranes  are  treated  with  a  solution  of  iodine  in 
iodide  of  potassium,  or  with  the  actual  cautery. 
The  skin,  hard  palate,  septum  nasi,  tongue,  and 
mucous  membrane  of  the  mouth  are  the  only  parts 
w^hich  can  be  reached  by  this  method. 

In  five  cases  the  effect  of  treatment  was  very  slow^, 
and  in  none  was  it  without  result.  Of  the  350  suc- 
cessful cases,  Bie  says  a  large  proportion  was  severe, 
having  been  unsuccessfully  treated  by  other  means. 
The  following  two  cases  selected  from  the  article  in 
question  serve  as  examples,  and  at  the  same  time 
present  the  details  of  treatment : 

"No.  192,  30  years  old.  Lupus  vulgaris  faciei  et  cavitatis  nasi. 
The  patient  has  been  suflfering  from  lupus  vulgaris  fifteen  years. 
Previous  treatment :  (i)  Cauterization  of  the  lupus;  (2)  homoeo- 
pathic treatment;  (3)  scraping  out  and  thermocauterization  during 
three  years.  The  disease  was  progressing  verj-  slowly  just  before 
the  beginning  of  the  treatment.  The  affected  places  were  swollen 
and  red.  Everywhere  numerous  nodules,  partly  confluent  with 
crusts  and  small  ulcerations,  no  large  ulcers.  A  number  of  dis- 
seminated nodules  in  the  healthy  skin.  There  was  an  extensive 
but  almost  quiescent  lupus  cavitatis  nasi.  June  i,  189S.  Treatment 
by  light  with  a  quartz  apparatus  and  a  lamp  of  50  amperes  one 
hour  a  day.  For  the  mucous  membrane  of  the  nose;  Compresses 
saturated  with  a  solution  of  mercuric  chloride  and  touching  with  a 
solution  of  iodine  and  potassium  iodide  {1:2:2)  once  a  week.     Sep- 


LUMBAGO.  391 

tember  30.  Steady  improvement.  No  ulcers  at  present.  The  skin 
of  the  nose  seems  to  be  health)'.  Everywhere  good  scar-tissue; 
hardly  any  nodules  \-isible.  October  29.  No  distinct  nodules. 
Treatment  discontinued.  November  15.  Everywhere  the  scar- 
tissue  is  smooth  and  but  little  visible.  No  distinct  nodules.  Janu- 
uary  19,  1899.     Letter  from  the  patient's  doctor.     No  relapse. 

"No.  84,  23  years  old.  Lupus  vulgaris  faciei,  cavitatis  nasi  et 
manus  dextrae,  phthisis  bulbi  dextri;  spina  ventosa  digiti  iii  sin- 
istri.  The  patient  has  been  suffering  from  lupus  for  seven  years. 
Prev-ious  treatment:  (i)  Ointment;  (2)  scraping,  several  times  re- 
peated; (3)  touching  with  iodine.  There  was  lupus  on  both  sides 
of  the  face  and  on  the  right  hand.  The  extent  of  the  disease  on 
the  left  part  of  the  face  was  about  the  same  as  on  the  right  half  of 
the  face.  The  dorsum  of  the  right  hand  was  affected  half  of  its  ex- 
tent, including  a  part  of  the  right  third  and  fourth  finger. 
The  lupus  consists  of  ulcers,  covered  with  crusts,  and  of  dissemi- 
nated non-ulcerated  nodules.  The  right  ala  nasi  was  almost  quiet 
destroj'ed.  October  18,  1897.  Light-treatment  of  the  face,  alter- 
nating every  two  daj-s  with  lamps  of  35  amperes  and  glass  ap- 
paratus during  two  hours,  and  lamps  of  50  amperes  and  quartz 
apparatus  during  one  hour.  February  19,  1899.  Hardly  any  im- 
provement. March  8.  A  slight  improvement  only.  April  13. 
Good  improvement.  The  apex  nasi  is  not  ulcerated.  The  ulcers 
of  the  cheeks  are  less  numerous,  small  and  superficial.  May  17. 
The  affection  of  the  face  is  constantly  improving,  no  ulcers,  a  few 
disseminated  nodules.  June  15.  Light-treatment  one  hour  every 
day  with  a  lamp  of  50  amperes  and  a  quartz  apparatus.  August  18. 
The  affection  of  the  face  apparently  cured.  No  distinct  nodules. 
October  25.  A  fine  scar-tissue  everywhere  on  the  face.  Still  a  few 
doubtful  patches.  Treatment  discontinued.  November  11.  The 
scars  on  the  face  are  sound,  only  two  small  solitary  nodules  on  both 
cheeks.     Light-treatment  a  few  times.     Maj' 24,  1899. " 

It  will  be  observed  from  the  above  that  a  special 
apparatus  is  necessary  for  applying  this  novel  and 
apparenth' successful  method.     (P.  M.J. ,10,  7,  99.) 


LUMBAGO. 

See  Muscular  Rheumatism. 


392  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


MEASLES. 

Sponging:  —  For  hyperpyrexia,  sponging  with 
water  at  90°  to  95°  may  be  employed,  or  if  this  is 
ineffectual  a  temperature  of  80°  may  be  advantage- 
ously substituted.  As  a  last  resort  cold  water  baths 
may  be  employed.     (Strr.) 

Cold  Baths  and  Cold  Pack: — When  there  is  high 
temperature  with  nervous  symptoms  nothing  is  so 
reliable.  The  temperature  of  the  bath  should  be  at 
first  100°,  then  gradually  lowered  to  85°  or  80° ;  the 
body  should  be  rubbed  briskly  while  in  the  bath,  and 
water  applied  to  the  head.  After  removal,  dry 
quickly  and  w^rap  the  patient  in  a  blanket.  The 
bath  should  last  from  five  to  twenty  minutes.  A 
cold  pack  may  be  applied  as  follows:  Strip  the 
patient  and  envelop  him  in  a  sheet  which  has  been 
wrung  out  in  water  at  a  temperature  of  100° ;  upon 
the  outside  of  the  sheet  rub  on  ice  over  the  entire 
trunk,  first  anteriorly  then  posteriorly ;  continue  this 
for  five  minutes  or  more,  according  to  indications; 
afterwards  roll  the  patient  in  a  blanket  without  the 
removal  of  the  pack.  The  head  should  be  sponged 
with  cold  w^ater,  and  hot  baths  if  necessary  should 
be  applied  to  the  feet.     (Hit.) 

Hot  Baths:  —  These  are  indicated  when  there  is 
high  temperature,  feeble  pulse  and  cyanosis,  condi- 
tions which  contra-indicate  cold  baths  or  cold  packs. 
Mustard  may  be  added ;  ice  should  be  applied  to  the 
head  during  the  bath.     (Hit.) 

Hot  Mustard  Baths: — At  a  temperature  of  100, 
half  an  ounce  of  mustard  to  the  gallon,  are  indicated 


MENINGITIS.  393 

in  malignant  types ;  the  patient  should  be  immersed 
up  to  the  neck  for  about  three  minutes,  removed 
quickly,  dried  and  placed  between  blankets,  or 
wrapped  in  blankets  and  dried  later.  Then  baths 
may  be  administered  ever}'  tw^o  hours.     (Strr.) 

Hot  Pack: — With  hot  water  or  mustard  water,  2 
drachms  to  the  gallon,  may  be  used  with  the  same 
indications  mentioned  for  hot  baths.  They  may  be 
renewed  every  half  hour.     (Strr.) 

Simple  washes  of  Borax,  gr.  x-gj,  or  Hot  ^Vater 
may  sometimes  be  necessary  for  the  eyes,  and  Do- 
bell's  Solution  for  cleansing  the  throat.     (Strr.) 

This  discovery  of  the  presence  of  pneumococci  in 
the  buccal  secretions  during  the  course  of  the  disease 
point  to  disinfection  of  the.  mouth.     (Hit.) 


MENINGITIS,  ACUTE  CEREBRAL— 
LEPTO-MENINGITIS. 

Extreme  quiet  and  avoidance  of  all  disturbing  in- 
fluences is  of  the  utmost  importance;  a  darkened 
room  is  advisable. 

An  Ice  Bag  should  be  kept  on  the  head,  and 
Leeches  may  be  applied  with  benefit  to  the  back  of 
the  neck  and  temples.     (Ty.) 

Blisters : — Applied  to  the  back  of  neck  are  useful, 
and  it  is  claimed  not  as  painful  as  appearances 
would  indicate.     (St.) 

Mercurial  Inunctions: — Are  recommended  when 
the  disease  is  non-tubercular.     (Ty.) 

Cold  Sponging: — Useful  to  relieve  fever.     (An.) 

Surgical  Interference  should  be  promptly  resorted 
to  when  there  is  disease  of  the  middle  ear. 


394  DIGEST   OF    EXTERNAL   THERAPEUTICS. 


MENINGITIS,  CEREBRO-SPINAL. 

Hot  Baths: — Have  been  used  successfully;  the 
patient  receiving  twelve  baths  at  a  temperature  of 
104°  in  three  days.  (Sj.)  Warm  baths  are  highly 
beneficial  in  lessening  the  tendency  to  spasm. 

Aspiration  of  Cerebro-Spinal  Fluid:  —  In  many 
cases  a  favorable  course  has  been  ascribed  to  punct- 
ure. A  simple  Dieulafoj^  needle  may  be  used,  or  a 
Pavaz  syringe;  puncture  is  made  between  the  lam- 
inae of  the  lumbar  vertebrae  a  little  to  one  side  of  the 
median  line.     (Sj.) 

Cold: — Is  generally  advised ;  baths  are  both  grate- 
ful and  valuable;  ice  bag  to  the  head  and  long  ice 
bag  to  the  spine.     (Bt.) 

Chloral  Hydrate: — In  1  drachm  doses  by  the  rec- 
tum should  be  administered  to  an  adult  for  the  con- 
vulsions.   No  other  remedy,  saj'S  Tj'son,  equals  it. 

Chloroform  or  Ether: — Inhalations  may  be  indi- 
cated in  desperate  cases.     (T3\) 

Morphine: — H3'podemiicall3'  affords  relief  to  the 
intense  headache,  mj-^algia  and  muscular  contrac- 
tions and  tones  the  heart.     (An.) 


MENORRHAGIA  AND  METROR- 
RHAGIA. 

As  a  rule,  external  treatment  is  unnecessary  for 
menorrhagia,  but  when  internal  remedies  alone  have 
failed,  thej  should  be  supplemented  bj'  these  meas- 
ures.   In  such  cases  an  examination  should  be  made 


MENORRHAGIA  AND  METRORRHAGIA.     395 

without  delay.  Rest  is  an  important  factor  and 
should  always  constitute  part  of  the  treatment.  (D.) 

Cold: — Cloths  wrung  out  in  cold  water,  or  better, 
ice  bags  to  the  hypogastrium,  or  small  rectal  injec- 
tions of  quite  cold  water.  (K.  C.)  Cold  sitz  bath 
with  the  feet  in  hot  water.     (Rd.) 

Heat : — A  hot  AArater  bag  applied  at  the  junction  of 
the  dorsal  and  lumbar  regions  reduces  congestion, 
and  controls  metrorrhagia  and  menorrhagia.  (F.) 
Vaginal  douches  of  water  at  a  temperature  of  125° 
to  135°  may  be  used  in  bad  cases.     (K.  C.) 

Hydrastine: — Is  indicated  for  haemorrhage  due  to 
metritis,  endometritis,  myomata,  or  incomplete  in- 
volution ;  a  10  per  cent,  solution,  hypodermically, 
acts  favorably.     (K.  C.) 

Astringent  Injections : — Small  injections  of  this 
nature  are  useful,  such  as  Alum,  gss-Oij.,  or  a  solu- 
tion of  Tannin  ;  the  latter  is  liable  to  stain  the  cloth- 
ing.    (D.) 

Tepid  Hip  Baths: — Are  advised  by  Baruch,  who 
claims  they  are  superior  to  any  internal  medicine. 
The  patient  is  to  be  placed  in  a  hip  bath  at  a  tem- 
perature of  85°,  in  which  she  is  to  remain  from  five 
to  eight  minutes ;  constant  friction  is  to  be  applied, 
followed  by  affusions,  or  preferably  the  circular 
bath.     (S.  B.) 

Puncture  of  Cervix: — Followed  by  the  application 
of  tampons  of  boroglyceride  is  sometimes  effective  in 
cases  of  chronic  congestion.     (Alb.) 

Antipyrin  and  Salol: — Equal  parts  heated  in  a  test 
tube ;  a  brown  liquid  is  obtained  w^hich  may  be  ap- 
plied with  absorbent  cotton  to  the  whole  endome- 
trium ;  it  is  said  to  be  painless  and  productive  of  ex- 
cellent results.     (Sj.) 


396         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Cotarnine  Hydrochloride  (Stypticin): — Is  a  very 
useful  remedy  ;  when  haemorrhage  is  ver3'^  profuse  in- 
ject 30  drops  of  a  sterilized  10  per  cent  solution  into 
the  gluteal  muscles.  (Sj.)  This  drug  is  said  to  be 
superior  to  ergot  or  hydrastis,  and  is  indicated  ^vhen 
there  is  subinvolution,  fungus  endometritis,  haemorr- 
hage from  fibroids,  and  at  the  climacteric. 

Conium: — Suppositories  of  2  to  4  grains  with 
glycerine  1  part,  gelatin  4  parts,  introduced  tw^ice 
daily,  form  an  excellent  anodyne  w^hen  the  condition 
is  associated  with  ovarian  disease.    (F.) 

Salicylic  Acid: — In  cases  not  dependent  upon  gross 
lesions,  tampons  moistened  with  a  solution  are  valu- 
able,    (F.) 

Hot  Saline  Enema: — Used  with  much  benefit  when 
the  patient  is  faint  from  the  loss  of  blood;  it  will 
also  tend  to  stop  the  flow.     (D.) 

Tamponing: — When  haemorrhage  is  severe,  or  in 
cases  when  it  is  not  practical  to  see  tht  patient 
often,  use  hot  douches,  then  pack  the  vagina  with 
tampons,  allov^ing  them  to  remain  twenty-four 
hours;  those  in  contact  with  the  cervix  may  be 
saturated  with  glycerite  of  alum.  If  this  measure 
fails,  the  cervnx  must  be  dilated,  and  the  whole 
uterine  cavitj-- packed.     (K.  C.) 


MILIARIA- PRICKLY  HEAT. 

Cold  Baths  or  Sponging  frequently  in  warm 
vsreather,  light  loose  clothing  and  light  bed  clothing. 
(Bt.) 

Borax  or  Boric  Acid  may  be  added  to  the  sponge 
bath.     (Bt.) 


MILIUM.  397 

Soothing  and  astringent  lotions  as  mentioned 
under  Acute  Eczema,  may  be  employed. 

Mild  and  astringent  powders  as  Zinc  Oxide,  Bis- 
muth Subnitrate,  Starch,  Lycopodium,  Kaolin,  and 
Camphor  Powder.     (Ja.) 

Lemon  Juice  has  a  soothing  eifect  in  allaying  irri- 
tation.    (Al.) 

Oil  of  Peppermint  in  cosmoline  is  recommended 
(Bt.),  but  ointments,  as  a  rule,  are  not  to  be  com- 
mended. 

Copper  Sulphate: — gr.  x— 5J,  much  used  in  the 
West  Indies .    ( Vn . ) 


MILIUM. 

Remove  the  little  pearl-like  deposit  by  squeezing, 
and  apply  a  drop  of  Iodine  or  Carbolic  Acid ;  or 
touch  with  Nitrate  of  Silver  (Vn.);  or  the  skin  may 
be  washed  with  Soap  Bark  water  and  gentlv  rubbed. 
(Kp.) 


MOLES. 

See  Naevus  Pigmentosus. 

MUCOUS  PATCHES. 

Cleanliness  is  of  paramount  importance ;  the  teeth 
should  be  cleansed  at  least  tw^ice  daily  with  some 
antiseptic  mouth  wash;  for  this  purpose  solutions 


398  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

of  Boric  Acid,  Borax,  Myrrh,  Chlorate  of  Potash, 
Sodium  Bicarbonate  are  useful.  The  same  solutions 
may  be  also  employed  as  gargles  and  sprays  for  the 
pharynx. 

The  following  is  one  of  the  best  combinations  for 
this  purpose : 

9^.    Sod.  Boratis,  jiij. 

Tr.  Catechu.,  |ss. 

Tr.  Myrrhae,  §ss. 

Aquae,  ^vij. 
M.  (CI.) 

Another  useful  formula : 

9;.    Tr.  Myrrhse,  ^ss. 

Potass.  Chloratis,  3iij- 

Aquae,  q.  s.  ad  ^vj. 

M.  (Sn.) 

Dobell's  Solution,  solutions  of  Alum  and  Hama- 
melis  also  beneficial.     (CI.) 

Nitrate  of  Silver: — A  few  applications  of  the  solid 
stick  or  a  solution,  varying  from  5  to  20  grains  to 
the  ounce,  will  frequently  cause  rapid  healing. 
Lesions  of  the  nasal  mucous  membranes  may  be 
treated  by  sprays  of  5  to  10  grains  to  the  ounce. 
(B.H.) 

Acid  Solution  of  Nitrate  of  Mercury: — One  of  the 
most  successful  applications  for  all  forms  of  syphi- 
litic sores  of  the  tongue  and  mouth.  The  strength  of 
the  solution  must  vary  according  to  the  object  in 
view.  For  ulcers  of  the  throat  1  or  2  minims  of  the 
acid  in  an  ounce  of  water  may  be  used  as  a  gargle  or 
with  the  atomizer,  care  being  taken  that  none  is  in- 
haled or  swallowed.  A  mixture  of  the  strength  of  a 
drachm  to  the  ounce  of  w^ater  may  be  used  for  appli- 
cation w^ith  a  mop.     (N.) 


N^VUS  PIGMENTOSUS — MOLES.  399 

Glycero-Iodine  (iodine  gr.  x,  ghxerine,  3J) : — Gives 
quicker  results  than  the  acid  nitrate  of  mercury. 
(CI.) 

Potass.  Chlorate: — 20  grains  to  the  ounce,  is  rec- 
ommended as  a  mouth  wash  to  be  used  as  a  prevent- 
ive.    (Al.) 

Sulphite  of  Soda: — 1  drachm  to  the  ounce.     (Al.) 

When  patches  are  not  located  on  the  mouth,  wash 
with  a  solution  of  Bichloride  of  Mercury,  1—2000, 
then  dust  with  equal  parts  of  Calomel  and  Subni- 
trate  of   Bismuth.     (Sn.) 


NyEVUS  PIGMENTOSUS— MOLES. 

Caustics: — Are  the  best  remedies  for  applying  to 
small  moles.  Nitric  or  Acetic  Acids  should  be  pre- 
ferred, the  surface  being  touched  with  these  agents. 

Electrolysis: — Is  adopted  for  the  removal  of  hairy 
growths  and  large  moles.     (Mor.) 

Removal  by  Excision: — All  large  moles  w^ill  require 
an  operation  for  their  removal;  small  ones  may  be 
removed  by  an  elliptical  incision. 

If  there  is  any  tendency  to  inflammation  or  malig- 
nant proliferation,  immediate  removal  by  the  knife  is 
demanded.  The  employment  of  caustics  and  irri- 
tants under  these  conditions  is  harmful.     (W.) 

All  methods  of  removal,  it  must  be  remembered, 
will  have  a  slight  scar. 


N^VUS  VASCULARIS. 

Early  treatment  is  generally  advisable  for  the  cap- 
illary variety  and  small  growths. 


400  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

The  methods  of  treatment  consist  of  Excision  and 
Caustics  for  port  wane  marks,  Scarification  and 
Electrolysis  for  venous  nasvi ;  in  the  latter  instance, 
when  the  size  and  location  contra-indicate,  Ligation 
may  be  substituted. 

Electrolysis: — Is  the  best  method  for  the  majority 
of  these  growths.  In  the  capillary  variety,  and  in 
port  wine  marks,  it  is  best  applied  by  making  mul- 
tiple punctures  in  parallel  lines  perpendicularly  to 
the  skin  and  entirely  through  it.  By  this  method  it 
is  possible  to  destroy-  small  naevi  and  to  diminish  the 
disfigurement  of  port  wine  marks.  A  scar  will  be 
left,  but  it  is  much  less  conspicuous  than  the  naevus. 
The  use  of  a  single  needle  scars  less  than  a  group; 
the  punctures  should  be  made  at  least  a  sixteenth  of 
an  inch  apart.  Applications  must  be  repeated  until 
the  naevus  is  destroyed ;  the  entire  point  should  be 
gone  over  at  each  application.  An  interval  of  two 
weeks  should  elapse  between  each  treatment.   (Ja.) 

Parenchymatous  Injections: — Various  agents  have 
been  used,  viz.:  Carbolic  Acid,  2  per  cent,  solution, 
injections  of  5  to  10  minims  as  in  carbuncle;  Tr. 
Chloride  of  Iron,  Tr.  Cantharides  are  recommended 
by  some,  but  there  is  danger  of  producing  embolism 
unless  it  is  possible  to  isolate  the  growth. 

Alcohol: — Injections  of  5  to  7  minims  of  a  95  per 
cent,  solution;  the  naevus  should  be  encircled  by  a 
ring  on  which  pressure  is  made  to  arrest  the  circula- 
tion, and  the  point  of  the  sj'ringe  slowly  withdrawn 
during  injection.  The  tumor  will  gradualh^  solidify. 
The  injections  may  be  repeated  at  intervals  of  sev- 
eral weeks,  until  disappearance  of  the  growth  is 
effected.     (Al.) 

Carbolic  Acid  Tattooing: — A  method  so  termed  is 


N^VUS   VASCULARIS.  401 

said  to  give  excellent  results,  leaving  little  or  no 
scarring.  It  consists  of  puncturing  the  aifected  area, 
a  portion  at  a  time,  with  a  number  of  small  fine 
needles  bound  together;  these  are  first  dipped  in  a 
50  per  cent,  or  stronger  solution  of  carbolic  acid. 
The  surface  should  be  prepared  by  vi^ashing  with 
alcohol.  After  ^ipplication  collodion  is  freely  applied 
for  pressure  and  protection.     (F.) 

Ligation:  —  Suited  to  some  forms  of  vascular 
growths,  though  electrolysis  is  generally  preferred ; 
venous  njevi  too  large  to  permit  of  excision  may  be 
ligated.     (T.,  97.) 

Linear  Scarification: — As  employed  in  acne  rosa- 
cea, to  which  the  reader  is  referred,  gives  good  re- 
sults in  small  nasvi  and  telangiectasis ;  it  is  not  suit- 
able for  larger  growths. 

Excision:  —  With  subsequent  transplantation  by 
the  method  of  Thiersch,  is  the  only  reliable  remedy. 

Nitric  Acid,  Glacial  Acetic  Acid,  Trichloracetic 
Acid,  Monochloracetic  Acid  are  used  as  cauterants, 
but  are  uncertain  in  their  effects. 

Collodion: — Emploj^ed  on  account  of  its  contractile 
power.  It  is  employed  for  capillar^'-  nasvi  in  children 
and  as  a  base  combined  with  active  agents,  viz.: 
Bichloride  of  Mercury  gr.  viij-^j,  it  forms  a  caustic 
useful  for  small  nasvi ;  a  circle  of  pure  collodion  should 
first  be  applied  around  the  naevus,  to  protect  the 
healthy  integument;  a  single  application  is  usually 
sufficient ;  a  dr3'  eschar  follows  which  separates  in  a 
few  days.  (Al.)  Salicylic  Acid  and  Lactic  Acid,  10 
parts  of  each,  with  collodion  80  parts,  is  also  used 
for  small  growths .     ( F . ) 

Creosote: — More  or  less  diluted,  applied  two  or 
three  times  a  day,  is  said  to  give  excellent  results. 
27 


402  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Excoriation  and  ulceration  is  at  first  produced, 
which  is  finalh^  followed  bj- healing.     (F.) 

Chromic  Acid: — Punctures  with  needles  dipped 
into  a  50  per  cent,  solution  have  been  foUow^ed  -with 
success.     (Kp.) 

Sodium  Ethylate: — Is  one  of  the  best  caustics, 
causes  little  pain,  should  be  applied  on  the  end  of  a 
glass  rod.  To  avoid  scarring,  only  a  small  part  of 
the  naevus  should  be  treated  at  one  time.  A  crust 
will  form  which  should  be  left  undisturbed.     (Kp.) 


NASAL  POLYPUS. 

Destructive  in  situ  bj'  injection  of  such  agents  as 
Chromic  Acid,  Tincture  of  Iodine,  or  Tannic  Acid, 
3J~oj,  niay  be  successful,  but  it  results  in  a  necrotic 
mass  which  remains  in  the  nasal  cavity'  as  an  offen- 
sive body  until  it  sloughs  away.  When  the  polypi 
are  numerous,  this  treatment  is  obvioush-^  distress- 
ing. The  best  method,  therefore,  for  the  removal 
of  these  grow^ths  is  by  the  Wire  Snare.  RemoA^al  by 
forceps,  formerlj'  much  practiced  and  still  used  to 
some  extent,  is  condemned.  After  removal  by  the 
snare  the  pedicle  may  be  touched  by  the  galvano- 
cautery. 

Sodium  Ethylate: — Saturate  a  bit  of  cotton  with 
the  drug  and  apply  tw^o  or  three  minutes ;  then  wath- 
draw ;  the  mass  of  polypi  will  be  almost  immediately 
destroA^ed.  Touch  the  base  with  the  same.  The  ap- 
plication causes  slight  burning  pain  and  occasion- 
ally moderate  haemorrhage.     (Al.) 

Tannic  Acid: — In  the  small  vascular  variety,  and 
in  case,  where  the  growth  is  soft  and  small,  there  is 


NASO-PHARYNGEAL   CATARRH.  403 

ever}"  prospect  of  temporary,  if  not  permanent  relief, 
by  applications  of  the  fine  powder  t^vo  or  three 
times  a  day.     (Wt.) 

Suprarenal  Extract:— The  application  of  this  agent 
preparatory  to  removal  will  prove  effective  for  the 
control  of  heemorrhage.  See  Adenoid  Grow^ths  of  the 
Pharynx. 


NASO-PHARYNGEAL  CATARRH, 
CHRONIC. 

See  Chronic  Rhinitis. 

Local  treatment  is  similar  to  that  of  chronic  rhin- 
itis, to  which  the  reader  is  referred ;  little,  therefore, 
can  be  added. 

Important  exceptions  are  the  use  of  the  post-nasal 
syringe  for  cleansing  purposes,  and  the  application^ 
of  sprays  through  the  mouth.  Muco-purulent  dis- 
charges should  be  removed  twice  daily  by  Avashes 
and  douches. 

The  following  will  prove  satisfactory  for  this  pur- 
pose, having  a  tendency  to  control  all  proliferations 
as  well  as  to  dislodge  the  mucus : 


M. 


Acid.  Carbolici, 

gr.  "J' 

Potass.  Chloratis, 

SJ. 

Glycerini, 

Sj. 

Aquae, 

ad  q.  s.   Svj. 

404  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Or, 

^.    Zinc.  Sulpho-carbolatis,  gr.  iij. 

Acid.  Salicylici,  5J- 

Aquse,  S^j- 

M.  (Bos.) 

Sodium  Bicarbonate: — A  solution  of  10  grains  to 
the  ounce  (Iv.),  or  the  following  are  useful  for  cleans- 
ing purposes : 

9.    Sodii  Bicarbonatis, 

Sodii  Boratis, 

Sodii  Chloratis,  aa  gr.  j. 

Sac.  Albi,  gr.  xxxvj. 

M. 
Sig.     Dissolve  in  wineglassful  of  hot  water. 

Another  useful  formula  is  the  following : 

T^.     .-J-Naphtholi,  gr.  xlv. 

Alcoholis,  5^- 

M. 
Sig.     A  teaspoonf ul  to  a  quart  of  boiled  water.     ( T. ,  98. ) 

After  cleansing,  the  following  will  also  be  found  of 
service : 

Gallic  Acid: — By  insufflation  in  the  proportion  of 
1  grain  to  2  of  gum  acacia  forms,  according  to  Ivins, 
a  most  grateful  and  beneficial  application. 

Glycerites  of  Iodine  or  Zinc  Chloride,  viz.: 

ffe.    lodi.,  gr.  X. 

Glycerini,  3j. 

M. 

Or, 

¥fc.    Zinc.  Chloridi,  gr.  x. 

Aquae,  5j. 

M.  (Iv. ) 


NEURALGIA.  406 

To  effect  a  cure,  radical  measures  and  strong  appli- 
cations are  necessary,  such  as  the  following : 

Tr.  Iodine,  Glycerole  of  Tannin,  or  Nitrate  of  Sil- 
ver (gr.  xx-xxx-^j),  application  to  be  made  at  in- 
tervals of  three  days  or  a  week.  Also  Lactic  Acid, 
3ss-j-§j,  or  Monochloracetic  Acid,  undiluted  for  the 
hypertrophies.  In  making  strong  applications  great 
care  should  be  taken  not  to  touch  the  palate. 

Chromic  Acid: — May  be  applied  with  good  effect 
to  the  broad,  flat,  thickened  condition  of  the  glandu- 
lar structure  of  the  pharynx. 

Galvano-Cautery : — May  be  employed  when  other 
measures  have  failed  for  the  reduction  of  the  hyper- 
trophy.    (Iv.) 


NEURALGIA. 

Dry  Heat: — One  of  the  best  palliatives  during  par- 
oxysms ;  may  be  applied  by  means  of  hot  w^ater  bag, 
hot  hop  bag,  or  Japanese  fire  box.     (Gn.) 

Aconite: — Is  useful,  especially  in  neuralgia  of  the 
fifth  pair  (R.);  may  be  applied  as  an  ointment,  or 
the  tincture  may  be  painted  on  the  affected  area.  It 
also  enters  into  the  formation  of  various  liniments, 
viz.: 


1^.    Tr.  Aconiti, 

33- 

Ol.  Sinapis, 

^h 

Glycerini, 

n 

Spts.  Rectificati, 

Svj. 

M. 

Sig.     Rub  in  about  2 

teaspoonfuls  on 

affected  part  night  and 

morning. 

The  following  is  said  to  be  still  more  efficacious : 


406    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

^.    Tr.  Aconiti,  3J. 

Camphorse,  3ij. 

Chlorof  onni ,  3  i  j . 

01.  Cajuput.,  gij. 

Tr.  Capsici,  jij. 

Spts.  Rectificati,  ad  ^vj. 

M. 
Scent  with  oil  of  origanum.     (T.,  98.) 

Aconitia : — In  the  form  of  an  ointment  (2  grains  to 
the  drachm),  or  a  2  per  cent,  solution  of  the  oleate  in 
oil,  will  afford  marked  relief.  Its  local  use  being  not 
free  from  danger,  caution  must  be  exercised;  never 
apply  over  denuded  surfaces.     (F.) 

The  following  is  Ludlow's  formula,  which  is  rec- 
ommended for  "any  local  pain;"  a  portion  the  size 
of  a  pea  is  to  be  rubbed  in  over  the  affected  part.  It 
is  also  serviceable  in  inflammation  of  joints ; 

9?.    Aconitinse,  gr.  iss. 

Atrop.  Sulphatis,  gr.  ss. 

Ol.Tiglii.,  M.ij. 

Petrolati,  ^j. 

M.  (Sm.) 

Anodyne  Colloid : — The  following  mixture  is  highly 
recommended ;  it  forms  a  collodion  which  is  brushed 
over  painful  parts  five  or  six  times,  forming  success- 
ive films.  Absorption  of  the  alkaloid  may  be  facili- 
tated, if  desired,  by  covering  with  spongo-piline : 

V-    Amyl.  Hydratis, 

Collodii  (B.  P.),  aa  .^j. 

Aconitinge,  gr.  j. 

Veratrinae,  gr.  vj. 

M.  (T.,  97.) 

Apone : — A  preparation  specially  so-called  is  made 
as  follows:  Capsicum,  §viss,  aq.  ammoniae,  Siij^ij, 
thymol,  chloral  hydrate,  aa  siiss,  alcohol,  Oij.    The 


NEURALGIA.  407 

capsicum  is  macerated  for  a  month  in  the  alcohol 
and  the  ammonia  mixed ;  it  is  then  expressed  and 
the  thymol  and  chloral  added.  The  preparation  is 
then  painted  on  the  skin  pure  or  diluted.     (F.) 

Belladonna: — The  extract  thinned  with  g-lycerine, 
and  painted  on,  is  effective  (Ty.);  the  liniment  and 
ointment  is  especially  recommended  in  intercostal 
and  facial  forms.     (R.) 

Capsicum: — Is  used  in  a  strong  infusion  which  is 
applied  on  lint  and  covered  with  gutta  percha.     (R.) 

A  plaster  may  be  made  by  incorporating  the  tinct- 
ure with  gum  arable  and  spreading  the  mixture  on 
paper.     ( F. ) 

Chloral  Camphor:  —  Equal  parts  triturated  is 
sometimes  useful.  Morphia  may  be  added  with 
advantage.     (B.) 

Counter-Irritation: — Will  often  afford  relief,  sina- 
pisms, an  ammonia  rubefacient,  and  in  some  cases  a 
cantharides  blister  may  be  applied  wath  benefit  over 
the  affected  nerve.  (Al.)  The  latter,  though  often 
of  service,  has,  however,  been  superseded  by  more 
modern  and  less  disagreeable  measures. 

Chloroform: — A  deep  injection  of  from  5  to  15 
minims  in  the  neighborhood  of  an  affected  nerve  has 
been  found  extremel3'^  valuable.  Long-standing  neu- 
ralgias of  the  superficial  division  of  the  fifth  pair 
have  been  relieved.  Tyson  says  spirits  of  chloro- 
form should  be  used.  This  remedy  must  be  em- 
ployed cautiously,  as  it  maj^  cause  sloughing,  though 
rarely  does  any  local  trouble  ensue  except  tempor- 
ary induration.  The  same  \vriter  recommends  it 
more  especiall3'  for  sciatica.  Chloroform  enters  into 
the  formation  of  various  anodyne  liniments ;  a  useful 
one  is  as  follows : 


408  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

5fc.    Chlorofomii, 

Tr.  Aconiti,  aa  ^ss. 

Lin.  Saponis,  ^j. 

M. 

Sig.     Moisten  a  bit  of  flannel  and  apply  covering  with  oiled 
silk. 

The  following  form  effective  counter-irritant  lini- 
ments : 

ffc.    Chloroformi, 

Ol.  Terebinthinae,  aa  ^j. 

Lin.  Saponis,  ^ij. 

M. 

Or, 

Jfc.    Chloroformi, 

Lin.  Camphorae,  aa  ^j. 

M.  (B.) 

Cocaine: — Might  be  expected  to  constitute  a  useful 
palliative,  but  in  order  to  obtain  action  through  the 
skin  it  must  be  only  employed  in  ointments  or  solu- 
tions in  the  strength  of  10  to  15  per  cent.  A  20  per 
cent,  solution  dissolved  in  oil  of  cloves,  5  to  10 
minims  being  rubbed  in  w^ith  the  finger  over  the  seat 
of  pain,  is  recommended.  Strong  solutions  must  be 
used  with  caution  on  mucous  surfaces.  The  hypo- 
dermic use  is  more  effective;  the  dose  is  V4,  grain. 
The  danger  of  forming  the  cocaine  habit  must 
alw^ays  be  taken  into  consideration.     (Ty.)    (Sm.) 

Guaiacol: — Compresses  wet  w^ith  15  drops  to  1 
drachm  and  placed  over  the  part  are  reported  to 
afford  almost  instant  relief.  The  drug  should  be 
pure  and  left  in  contact  with  the  skin  only  a  short 
time,  otherwise  absorption  may  occur  which  may 
produce  fall  of  temperature  and  symptoms  of  col- 
lapse. 


NEURALGIA.  409 

The  following  solution  is  to  be  painted  on  two  or 
three  times  a  day,  covering  the  part  afterwards  w^ith 
cotton : 


p.    Mentholi, 

Guaiacoli, 

aa  gr.  xv. 

Alcoholis  Absoluti, 

3v. 

M. 

Sig.     Use  little  less  than  a  drachm. 

(' 

(T.,97.) 

Ether:  —  In  15  drop  doses,  subcutaneously,  or 
mixed  w^ith  alcohol  and  injected  as  near  as  possible 
to  the  seat  of  pain,  has  been  successful  in  rheumatic 
neuralgias,  sciatica,  and  torticollis.     (Sm.) 

Essential  Oils : — These  have  the  pov^er  to  relieve 
the  pain  of  sensory  nerves,  especially  the  oil  of  cloves, 
a  solution  of  v^hich  in  rhigoline  is  a  nostrum  for 
superficial  neuralgia. 
The  follow^ing  combination  may  be  employed : 


9:.    Ol.  Caryophylli, 

Ol.  Gaultheriae, 

Ol.  Thy  mi, 

aa  3J- 

Tr.  Benzoini, 

Tr.  Cinnamomi, 

aa  giv. 

M. 

Sig.     Appl)'  with  lint 

and 

cover 

with  oiled  silk.     (B. 

Methyl  Chloride: — Is  an  effective  analgesic  in  the 
form  of  a  spray.  Employed  in  this  manner  it  is  often 
very  satisfactory  in  many  forms  of  neuralgia,  A 
large  percentage  of  cures  has  been  reported.     (B.) 

Morphine  — By  hypodermic  injection  aifords  relief 
in  all  forms,  but  should  only  be  employed  as  a  last 
resort  because  of  the  danger  of  forming  the  habit. 
(Gn.)    This  is  especially  true  in  chronic  forms. 

Osmic  Acid: — A  1  per  cent,  solution  in  water  and 
glycerine  has  been  used  with  good  effect  by  hypoder- 


410  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

mic  injection  over  the  course  of  the  nerve  in  sciatica. 
(Ty.) 

Peppermint  Oil: — Maj^  be  painted  along  the  course 
of  the  nerve,  or  applied  with  cotton,  often  with  good 
effect.  (Sm.)  Combined  as  follows,  it  has  been  found 
of  great  service  in  neuralgic  and  other  forms  of 
headache : 


Oil  of  Peppermint, 

5  parts. 

Essential  Oil  of  Mustard, 

I  part. 

Camphor, 

2  parts. 

Ether, 

ID  parts. 

Rectified  Spirit, 

30  parts. 

Apply  with  ia  camel's  hair  brush. 

(T., 

97. 

Veratrine: — In    the    following    formulae;    a    small 
quantity  is  rubbed  over  the  seat  of  pain : 


Veratrine,  2  parts. 

Oleic  Acid,  98  parts. 


Or, 


Veratrine,  4  parts. 

Alcohol,  6  parts. 

Benzoated  Lard,  98  parts. 

(H.) 

Actual  Cautery: — This  maj^  be  used  to  great  ad- 
vantage in  the  treatment  of  long-standing  cases, 
especially  of  the  larger  nerve  trunks,  when  other 
measures  have  failed.  The  probable  occurrence  of 
scars  must  be  taken  into  consideration.     (F.) 

Strychnine  : — Subcutaneously,  in  full  doses,  is  of 
benefit  when  impaired  nutrition  is  the  cause.     (Ty.) 

Electricity: — Preferably  in  the  form  of  galvanism, 
is  valuable  in  many  cases ;  the  positive  current  over 
sensitive  points,  negative  over  the  spine  at  supposed 
origin  of  irritation.    The  strength  will  vary  from  5 


NEURASTHENIA,  411 

to  35  milliamperes,  according  to  the  susceptibility  of 
the  affected  part.  (Gn.)  While  the  constant  current 
is  most  frequently  employed,  faradism  may  also  be 
used.  Experience  has  shown  that  the  direction 
of  the  current  may  be  ignored,  though  it  is  com- 
monly recommended  to  place  the  positive  pole  over 
the  painfiil  part.  A  sedative  effect  is  best  obtained 
by  a  weak  galvanic  current,  just  enough  to  produce 
a  trembling  sensation.     (H.) 

The  application  of  drugs  by  electricity  has  been 
successfully  employed,  the  drug  in  solution  being  ap- 
plied with  the  positive  pole  with  a  speciallj^  con- 
structed electrode.  Cocaine  (10  per  cent,  solution) 
will  give  relief  which  will  last  about  eleven  hours ; 
10  to  15  milliamperes  should  be  used  for  from  five  to 
fifteen  minutes.  Morphine  ma3^  be  administered  in 
the  same  way.     (H.) 

Mud  Baths: — Such  as  those  of  St.  Armand,Schwal- 
bach  and  Franzenbad  are  of  great  benefit  in  chronic 
forms  dependent  upon  debility,  neurasthenia  and 
hysteria.     (Ty.) 

Acupuncture  and  Aquapuncture : — These  measures 
are  of  service,  the  latter  often  remarkably  beneficial. 
(B.) 

Excision: — Has  been  used  as  a  last  resource,  with 
success  and  failure.     (Ty.) 


NEURASTHENIA. 

The    measures     recommended     for     hysteria    are 
equally  applicable  to  this  condition. 


412  DIGEST   OF   EXTERNAL  THERAPEUTICS. 


NIPPLES,  FISSURED  AND  SORE. 

Wash  the  nipples  before  each  nursing,  and  to 
harden  them,  apply  daily  Green  Tea,  Brandy,  Al- 
cohol, Port  ^Vine,  Hamamelis,  or  Lime  Water. 
(Bt.) 

For  painting  on  the  part  after  preliminary  disin- 
fection the  following  protective  preparations  are 
efficacious:  Collodion;  Gutta  Percha  (dissolved  in 
Chloroform),  which  has  the  advantage  of  not  being 
soluble  in  the  child's  saliva;  and  Benzoin,  Avhich 
forms  a  protective  varnish  of  great  value.  The  lat- 
ter is  also  useful  mixed  with  equal  parts  of  glycerine. 
(Bt.) 

Glyceroles,  or  lotions  of  Hydrastis,  Calendula, 
Arnica,  Hamamelis,  Phytolacca,  and  Borax  are  all 
used  in  the  proportion  of  a  drachm  of  the  remedy  to 
half  an  ounce  of  glycerine. 

Tannate  of  Glycerine,  Cerates  of  Graphites,  Car- 
bolic and  Boric  Acids,  Hamamelis,  Hydrastis,  Cal- 
endula, and  Phytolacca.     (Bt.) 

Nitrate  of  Silver: — The  craj'on  touched  to  the  nip- 
ple carefiilly  and  gently  is  sometimes  very  effective 
w^hen  the  part  is  ulcerated.  (Hpl.)  Agnew^  advised 
the  application  of  a  50  per  cent,  craj^on  to  the  bot- 
tom of  the  fissure  in  obstinate  cases.  The  nipple 
should  first  be  cleansed  thoroughly  and  afterward 
washed  with  a  little  milk  and  w^ater,  a  dressing  of 
zinc  oxide  ointment  is  said  to  complete  the  cure. 

Nitrate  of  Lead: — As  a  cicatrizing  astringent  is 
very  useful  dissolved  in  glycerine  or  brandy  in  the 
proportion  of  gr.  x— 5j.    It  should  be  applied  after 


NODES.  413 

nursing  and  the  child  should  not  be  allowed  to  take 
the  breast  until  the  nipple  has  been  thoroughly 
washed.     (N.) 

Rhatany: — As  an  ointment  or  wash  has  been  very 
successful.  (Wa.)  Use  a  watery  solution  of  the  ex- 
tract, or  an  ointment  in  the  proportion  of  1  part  of 
the  extract  to  15  of  cocoa  butter. 

Iron : — An  effective  application  is  composed  of  2 
drachms  of  the  liq.  ferri  subsulphatis  v^nth  6  drachms 
of  glycerine.  This  is  applied  with  a  camel's  hair 
brush.     (B.) 

Cocaine : — 4  grains  with  distilled  water  1  ounce 
may  be  applied ;  wash  off  thoroughly  before  nursing. 
(Sn.) 

Shields  of  rubber  or  zinc  may  be  worn. 


NODES. 

Stramonium : — A  leaf  of  the  plant  soaked  in  spirits 
and  laid  on  the  part  will  often  act  as  a  palliative. 
(Al.) 

Mercurial  Plaster: — One  of  the  best  applications, 
especially  for  syphilitic  varieties.     (F.) 

Iodized  Vasogen:— Will  often  prove  effective  after 
mercurial  plasters  fail  to  relieve.  It  should  be  ap- 
plied with  caution  several  times  a  day.     (F.) 

The  following  ointments  will  be  found  of  service : 

Ijt.    lodi, 

Terebinth.  Canadensis,  aa  3iv. 

Colodii,  §iv. 

M. 
Sig.     Apply  with  a  brush. 


414  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Or, 

9;.    Morpliinae,  gr.  viij. 

Hydrarg.  Oleati  (loto  20  per  cent.),  gj. 

M. 
Sig.     Apply  with  a  brush. 

Or, 

p.    Hydrarg.  Biniodidi,  gr.  vij. 

Potas.  lodidi,  .►^j. 

Adipis,  Sj. 
M. 

Or, 

9!..  Cadmii  lodidi,  5j- 

Adipis  Prgeparati,  5J- 

Lin.  Aconiti,  5^j- 

M.  (Sn.) 


ONYCHIA. 

Lead  Nitrate: — Has  cured  cases.  It  should  be 
thoroughly  sprinkled  on  the  ulcerating  surface.  After 
a  day  or  two  the  crusts  which  forms  is  removed  and 
the  sore  takes  on  a  healthy  action.  Pain  and  fetor 
are  diminished  and  resolution  is  sometimes  complete 
in  a  week.     (Hel,) 

When  there  is  much  pain  the  following : 


9;.    Hydrarg.  Chloridi  Mitis, 

Pulv.  Opii, 

Ext.  Belladonnse, 

aa  gr.  iij. 

Ung.  Aq,  Rosae, 
M. 

%ss. 

(Vn.) 

OPHTHALMIA    NEONATORUM.  415 

Alumen  Usta: — Is  useful  in  the  following  wash : 

9;.    Aluminis  Ustee,  gr.  iij. 

•    Zinc.  Sulphatis,  gr.  ij. 

Plumb.  Acetatis,  gr.  ij. 

Aq.  Destill.,  5j. 
M.  (Al.) 

Resorcin: — 10  to  20  per  cent,  ointment  or  plaster 
will,  it  is  claimed,  often  abort  the  disease  if  seen 
early.     (Ja.) 

The  pustules  should  be  evacuated,  cleansed  -with 
Carbolic  Acid  solutions,  and  dusted  with  antiseptic 
po^wders  such  as  Europhen,  Airol,  Xanoform,  etc. 

Removal  of  Matrix: — This  is  recommended  for  cure, 
cutting  awa}'  the  entire  matrix ;  simple  evulsion  will 
not  answer.  After  removal  dress  wnth  iodoform. 
(Hel.) 


OOPHORITIS. 

See  Pelvic  Inflammation. 

OPHTHALMIA  NEONATORUM. 

In  the  first  stage,  strict  cleanliness,  constant  re- 
moval of  all  secretions,  and  the  use  of  antiseptic  irri- 
gations are  essential.  No  strong  or  irritating  solu- 
tion should  be  applied  at  this  period.  In  the  second 
stage,  and  not  until  then,  nitrate  of  silver  is  the  sov- 
ereign remedy.  If  only  one  eye  is  affected  the  other 
should  be  protected,  being  securely  covered  in  every 


416  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

part  with  round  lintine  pads  slightly  larger  than  the 
orbit.  These  should  be  covered  with  sterilized  cot- 
ton, the  latter  with  gauze,  and  collodion  should  be 
smeared  around  the  whole  edge  of  the  pad  save  at  a 
point  at  the  lower  outer  region,  which  should  be  left 
for  ventilation.  The  protected  eye  should  be  in- 
spected every  second  daj-.  The  nurse  should  never 
carry  the  infant  in  her  arms. 

Antiseptic  douches  should  be  administered  as  pre- 
ventives to  -women  with  vaginal  discharges  just  be- 
fore confinement.  For  this  purpose  solutions  of  Bi- 
chloride of  Mercury  are  recommended.     (Mac.) 

Crede  advised  as  a  preventive  a  2  per  cent,  solution 
of  Nitrate  of  Silver  dropped  into  the  eyes  of  newly- 
born  infants.  Other  measures  have  also  been  ad- 
vised, Vk^ith  the  same  end  in  view,  but  none  are  as 
certain  in  their  effects  as  nitrate  of  silver.  If  the  dis- 
ease is  of  an  entirely  purulent  character,  active  and 
energetic  measures  should  at  once  be  instituted, 
otherwise  the  infant  will  lose  its  eyesight.  The  indi- 
cations are  essentially  the  same  as  those  of  purulent 
conjunctivitis  in  adults. 

The  general  line  of  treatment  may  be  summarized 
as  follow^s : 

1.  During  the  earlier  stages,  when  inflammation 
and  oedema  of  the  lids  is  severe,  in  addition  to  strict 
cleanliness  the  constant  application  of  Cold  should 
be  maintained  in  the  following  manner :  Take  square 
compresses  of  lint,  lay  them  upon  a  block  of  ice,  then, 
when  cold,  place  them  on  the  swollen  lids.  Change 
the  compresses  as  frequentlj^  as  it  is  needful  to  keep 
up  a  continuous  uniform  impression. 

2.  The  discharge  should  be  constantly  removed, 
to  accomplish  this  proceed  as  follows :    Gently  sepa- 


OPHTHALMIA   NEONATORUM.  417 

rate  the  lids,  wipe  away  the  tenacious  secretion 
with  bits  of  moistened  absorbent  cotton  and  irrigate 
the  conjunctival  sac  freely  with  an  antiseptic  solu- 
tion. Care  should  be  observed  not  to  permit  the 
point  of  the  pipette  to  come  in  contact  with  the 
cornea.  A  saturated  solution  of  Boric  Acid,  or  Bi- 
chloride of  Mercury  in  solution  not  greater  than  1 
grain  to  the  pint  maj^  be  used  for  irrigation;  the 
former  is  the  more  useful.     (T.,  96.) 

Nitrate  of  Silver : — As  soon  as  the  discharge  be- 
comes free  and  cream3^  the  remedy  should  be  applied 
as  follows :  Carefully  evert  lids  and  secure  exposure 
of  the  inflamed  tarsal  cartilage.  Remove  all  dis- 
charge of  lymph  by  irrigation ;  wipe  away  all  ad- 
herent particles  with  moistened  cotton  and  carefully 
touch  the  areas  thus  prepared  with  a  solution  of  10 
to  20  grains  to  the  ounce  by  means  of  a  cotton  mop. 
Neutralize  the  excess  with  a  solution  of  common  salt 
15  to  20  grains  to  a  cup  of  water.  Continue  apply- 
ing the  salt  solution  until  a  clear  red  surface  is  ob- 
tained, then  return  lids  to  position.  The  cornea 
should  be  carefully  inspected  before  leaving.  Finally 
apply  pure  vaseline  to  the  lids,  and  introduce  some 
within  the  conjunctival  sac.     (T.,  96.) 

Protargol  and  Argonin: — Advantages  are  claimed 
for  these  compounds  over  the  older  silver  salts  in 
treating  the  purulent  ophthalmia  of  children.  Both 
are  silver  proteid  compounds,  the  solutions  of  which 
cannot  be  precipitated  by  albuminous  fluids.  Pro- 
targol is  a  yellowish  powder,  readily  soluble  in  cold 
or  hot  water,  and  both  the  powder  and  the  solution 
keep  well.  Argonin  contains  4.2  per  cent,  of  silver. 
It  is  a  white  powder,  readily  soluble  in  slightly  warm 
water,  but  the  solution  is  turbid,  and  decomposes  if 
28 


418  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

exposed  to  too  much  heat.  When  so  decomposed,  it 
is  very  irritating.  Silver  nitrate  contains  6.35  per 
cent,  of  silver,  and  hence  occupies  a  middle  position 
in  this  respect  bet\veen  protargol  and  argonin. 

Argonin  in  a  2  per  cent,  solution  will  kill  gonococci 
in  a  short  time.  It  has  little  or  no  caustic  proper- 
ties. Protargol  is  more  powerful  and  should  not  be 
used  in  greater  strength  than  from  V2  to  1  per  cent. 
Under  its  influence  gonococci  wall  disappear  in  from 
two  to  four  weeks. 

Treatment  by  these  remedies  has  the  following  ad- 
vantages :  There  is  less  ulceration  of  the  cornea  with 
protrusion  and  imprisonment  of  the  iris,  an  earlier 
disappearance  of  all  inflammation,  a  quicker  eradica- 
tion of  the  gonococci,  less  pain  to  the  patient,  and 
more  prompt  restoration  of  the  injured  cornea  and 
conjunctiva.  In  preparing  solutions  of  argonin  use 
10  parts  of  cold  water  and  1  part  of  argonin.  This 
is  vigorously  shaken  in  a  flask  until  a  uniform  mix- 
ture is  obtained,  when  sufficient  boiling  water  is 
added  to  make  a  3  per  cent,  solution.  In  preparing 
a  solution  of  protargol  a  paste  is  first  formed  with 
the  powder  and  water  and  then  sufficient  water  is 
added  to  make  it  from  .25  to  2  per  cent.,  as  desired. 
Sodium  chloride,  cocaine,  atropine,  eserine,  and 
other  allied  substances  used  as  anodynes  for  the  eye 
can  be  administered  in  conjunction  with  protargol. 
Albuminous  substances  present  in  the  secretions  do 
not  decompose  it.  It  is  the  only  silver  compound 
know^n  that  is  not  affected  by  dilute  hydrochloric 
acid.  In  suppuration  of  the  lachrymal  sac,  stj'-es, 
etc.,  the  pus-formation  is  more  quickly  checked  b^^ 
protargol  than  other  agents.     (Ped.,  Vol.  7,  99.) 

Eserine: — A  solution  of  |  to  |^  S^~^h  o^^  drop 


ORCHITIS.  419 

three  or  four  times  during  the  da^'  according  to  se- 
verity of  the  case,  should  be  used  if  the  cornea  be- 
comes hazy  or  a  small  ulcer  forms  at  the  border.  At 
night  instill  Atropine,  2  drops  of  a  solution  of  4 
grains  to  the  ounce.  Caution  should  be  exercised 
lest  constitutional  eifects  of  these  drugs  be  obtained. 
If  corneal  haze  continues,  replace  cold  applications 
with  hot,  using  carbolized  water  at  120°.     (T.,  96.)' 

Potass.  Permang.: — Flushing  the  conjunctival  cul- 
de-sac  with  a  solution  of  1-5000  is  recommended. 
A  special  laveur  may  be  used  and  about  2  pints  ap- 
plied in  each  e3^e  twice  a  day.     (T.,  96.) 

Formalin  : — In  the  strength  of  1-1000  or  500  may 
be  employed  with  great  benefit  as  an  antiseptic  dur- 
ing the  stage  of  corneal  complication.  When  the 
ulcer  is  not  large  or  is  only  beginning  to  appear,  this 
treatment  is  strongly  indicated.     (N.  O.) 

Mercury  Oxycyanide  : — This  remedy,  it  is  claimed, 
has  antiseptic  powers  equal  to  those  of  the  bichlor- 
ide, with  the  advantage  of  being  less  irritating  and 
of  possessing  less  pow^er  of  coagulating  albumen. 
Solutions  of  1-500  have  proved  effective.     (T.,  98.) 

Iodoform: — Finely  powdered  and  dusted  on  the 
conjunctival  sac  after  cleansing,  is  employed ;  may  be 
applied  at  first  even  before  the  cord  is  cut.     (T.,  98.) 


ORCHITIS. 

Rest  in  bed  and  support  of  the  parts  as  in  epididi- 
mitis. 

Laudanum  or  Tobacco: — Applied  in  the  form  of 
stupes,  is  often  helpful.  A  piece  of  flannel  is  w^rung 
out  in  hot  water,  then  dipped  in  the  laudanum  or  a 


420  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

strong  infusion  of  tobacco  and  wrapped  around  the 
testicle.  Oiled  silk  is  placed  over  the  stupe  and  the 
parts  are  wrapped  in  cotton  and  lightly  bandaged. 
(B.H.) 

Carbolic  Acid: — A  2  per  cent,  spray  applied  for  fif- 
teen minutes  daily  is  highly  recommended.  The 
parts  are  afterwards  wrapped  in  cotton  and  sup- 
ported. This  spray  should  not  be  used  more  fre- 
quently than  the  time  mentioned,  for  fear  of  causing 
excoriation  of  the  skin.     (CI.) 

Belladonna  Ointment : — Spread  on  cloths  and 
wrapped  around  the  testicles  is  used  to  subdue  pain. 
(B.H.) 

Guaiacol: — Applied  to  the  groin  and  inner  aspect  of 
the  thigh  relieves  pain  and  lowers  temperature.    (Sj.) 

Poultices : — Should  be  used  with  caution.  In  the 
beginning  of  the  attack  applied  for  a  few  hours  they 
are  of  service.  Long  applied  they  increase  engorge- 
ment and  pain.  (B.  H.)  Hop  poultices  are  indicated 
both  in  specific  and  simple  orchitis.     (Al.) 

Ammonium  Chloride: — Forms  an  excellent  discuti- 
ent  application  in  inflammatory  swellings,  and  may 
be  emploji-ed  in  this  condition  when  applicable  in  the 
proportion  of  a  drachm  to  an  ounce  each  of  rectified 
spirits  and  w^ater.  Cloths  are  moistened  with  the 
solution  and  frequently  applied.     (B.) 

Ice: — Is  applied  with  the  hope  of  aborting  the  in- 
flammation, and  may  be  employed  if  the  patient  is 
seen  at  the  onset  of  the  attack.  But  its  continued 
application  is  not  desirable  if  the  disease  has  pro- 
gressed to  any  extent,  for  the  possibility  of  devitaliz- 
ing the  parts  and  causing  gangrene  after  effusion  has 
occurred,  must  be  taken  into  consideration.     (Mor.) 

Puncture  of   the  Tunica  Albuginea  :  —  Employed 


OTITIS  EXTERNA  CIRCUMSCRIPTA.  421 

with  gratifying  results ;  for  the  relief  of  pain  and 
tension,  it  is  very  generally  recommended.  (Mor.) 
Complete  antisepsis  should  be  observed. 

Suspensorj^    bandages  should  be  worn  after  con- 
valescence.    (Mor.) 


OTITIS  EXTERNA  CIRCUMSCRIPTA— 
FURUNCLE  OF  THE  AUDI- 
TORY MEATUS. 

The  following  are  useful  for  aborting  the  furuncle : 
the  Yellow  Oxide  of  Mercury,  gr.ij-§j,  or  the  Oleate, 
10  per  cent.,  as  ointments;  Nitrate  of  Silver  (the 
crayon  application);  and  Menthol,  10  to  15  per  cent, 
in  oil. 

For  a  soothing  effect,  the  follow^ing  emollient  oint- 
ments, painted  on  the  wall  of  the  meatus,  are  of 
benefit:  Cold  Cream,  or  W^hite  Precipitate,  gr. j— ij, 
Ung.  Aq  Rosae,  5J.  (Bn.)  Also  irrigations  with  hot 
water,  to  which  Laudanum  may  be  added  for  relief 
of  pain. 

Other  applications  which  maj^  be  employed  are : 

Carbolic  Acid  and  glycerine,  1-20. 

Burow's  Liquid,  see  Appendix  II. 

Liq.  Plumbi  Subacetatis  Dilutus,  a  few^  drops. 

Salicylic  Acid  in  collodion,  3J-5J. 

Tr.  Iodine  or  Pure  Glycerine  painted  on. 

Belladonna  Ointment. 

When  the  furuncle  has  formed,  it  should  be  incised 
by  Sexton's,  Buck's,  or  Politzer's  knife. 

After  incision  the  following  washes  should  be  used 
for  irrigation,  and  for  loosening  crusts  of  discharge : 


422  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Mercuric  Bichloride,  1-10,000. 
Sodium  Bicarbonate,  gr.  x-xx-,^j. 
Borax,  gr.  x-xx-y.     (Bl.) 


OTITIS  EXTERNA  DIFFUSA. 

Heat  and  Moisture: — Applicable  to  simple  cases. 
Use  an  irrigating  douche  of  hot  water,  or  frequent 
instillation  of  hot  water  into  the  upturned  ear. 
These  maj'  be  repeated  as  often  as  the  patient 
desires.  Laurel  water  may  be  substituted  for  plain 
w^ater. 

.  The  following  are  useful  instillations  for  the  relief 
of  pain : 

1^.    Morph.  Sulphatis,  gr.  iv. 

Aquse,  jij. 

M. 
Sig.     lo  drops  warm  in  the  ear. 

9:.    Atrop.  Sulphatis,  gr.  j. 

Aquae,  |j. 

M. 
Sig.     5  drops  wami  in  the  ear. 

Alcohol : — Pure,  instilled  into  ear  is  said  to  abort 
inflammation  and  reduce  swelling.     (Bn.) 

Incision : — May  be  employed  when  other  means 
have  failed  to  check  the  inflammation.  A  careful  ex- 
amination should  be  made  wdth  the  mirror  and  the 
most  inflamed  spot  located.  The  use  of  the  probe 
for  this  purpose  is  contra-indicated.  A  bold  inci- 
sion, clear  to  the  bone,  is  often  followed  by  relief  of 
pain  and  improvement.     (Bennett.) 

Mild  Syringing: — With  warm  water  with  carbol- 
ized  soap,  boric  acid,  borax,  salt,  or  bicarbonate  of 


OTITIS   EXTERNA  DIFFUSA.  423 

soda,  should  be  employed  when  the  discharge  is  sero- 
sanguinolent,  for  then  the  canal  is  exceedingly  ten- 
der and  intolerant  of  anA^  irritant  or  stimulant.  A 
cotton  wool  brush  may  be  employed  for  cleansing; 
exercise  care  in  its  application,  working  towards  the 
outlet  of  the  canal  without  undue  pressure.     (Bl.) 

Impalpable  Powders  or  solutions  of  Alcohol  are 
indicated  when  the  discharge  is  sero-purulent,  thick 
and  irritating.  Of  .the  powders,  the  most  effective 
are :  Boric  Acid ;  Berated  Calendula ;  Salicylate  of 
Chinoline  1  part,  with  16  of  boric  acid ;  Resorcin  1 
part,  boric  acid  8  parts;  Boric  Acid  and  Oxide  of 
Zinc,  equal  parts.  These  should  all  be  used  spar- 
ingly. The  most  effective  v^ay  in  which  to  applj^ 
these  powders  is  to  insert  an  ordinary  goose  quill 
into  one  end  of  a  flexible  rubber  tube,  the  free  end  of 
w^hich  is  held  in  the  mouth  while  the  other  is  dipped 
into  a  saucer  containing  the  powder,  a  little  of 
which  fills  the  quill,  which  is  aimed  at  the  desired 
part;  a  slight  puff  from  the  mouth  deposits  the 
powder. 

The  following  liquid  preparations  are  recom- 
mended : 

Boric  Acid,  saturated  solution. 

Zinc  Sulphate,  gr.  j-gj. 

Pyoktanin,  1-2000  or  1000. 

Solutions  should  be  used  warm  and  dropped  in. 

Nitrate  of  Silver  fused  on  the  end  of  a  silver  probe 
or  a  solution  on  a  cotton  v^ool  brush,  or  Alcohol  as 
strong  as  the  patient  can  bear  it,  are  suitable  agents 
for  the  reduction  of  redundant  grow^ths.     (Bn.) 


424  DIGEST   OF   EXTERNAL   THERAPEUTICS. 


OTITIS  MEDIA. 

ACUTE  CATARRHAL  OTITIS  MEDIA. 

Plantago: — A  glycerole  ma^-  be  made  of  the  fluid 
extract  from  the  fresh  plant  mixed  with  glycerine, 
equal  parts  distilled  and  filtered.  5  drops  hot  in  the 
ear  for  the  relief  of  pain  and  local  inflammation. 
(Ho.) 

In  the  following  combination,  it  is  said,  the  drug 
scarcely  ever  fails  to  relieve : 

9;.    Fid.  Ext.  Plantago  Maj.,  3iv. 

Tr.  Belladonnae,  gtt.  xv. 

Tr.  Aconiti  Radicis,  gtt.  x. 

Sol.  Morph.  Sulphatis  (Magendie),  gtt.  xx. 

Aq.  Destill.,  q.  s.  ad  5j- 
M. 

Sig.     4  or  5  drops  warm  in  the   ear  at  intervals  of  from  ten 
minutes  to  two  hours.     (Str. ) 

Another  combination  is  the  following : 

9;,    Fl.  Ext.  Plantago,  Maj.,  5j. 

Fid.  Ext.  Belladonnae,  gtt.  x. 

Glycerini, 

Aq.  Destill.,  aa  5"j- 

M. 
Sig.     A  few  drops  in  the  ear  for  pain.     (Bl. ) 

Morphia: — 5  to  10  minims  of  Magendie's  Solution 
may  be  dropped  into  the  ear  for  the  relief  of  pain,  re- 
peating the  doses  every  two  hours,  as  indicated. 
(Bl.) 

Mullein  Glycerole: — Take  fresh  flowers  (old  are  in- 
ferior), digest  in  Jamaica  rum  ten  days,  express  the 
extract,  and  use  equal  parts  with  glycerine  and  dis- 


OTITIS  MEDIA.  425 

tilled  water.  An  excellent  preparation  wath  which  to 
follow  hydrogen  peroxide,  which  should  never  be 
used  alone.     (Ho.) 

Atropia : — In  the  following  combination  may  be 
dropped  into  ear  for  relief  of  pain  : 

Jfc.    Atroph.  Sulphatis,  gr.  ij. 

Acid.  Borici,  gr.  x. 

Aq.  Destill.,  gj. 
M.  (Bn.) 

Cocaine  Hydrochlorate: — 4  per  cent,  solution,  a 
few  drops  in  ear  for  relief  of  pain. 

Local  Abstraction  of  Blood: — Is  valuable  in  the 
first  stages  of  both  acute  and  purulent  forms. 
Leeches  are  of  great  value  in  those  cases  attended 
with  intense  pain  and  when  there  is  great  hyperas- 
mia,  infiltration  of  parts  and  engorgement  of  the 
periosteum  and  mucous  membrane.  In  many  in- 
stances further  progress  of  disease  is  arrested.  Arti- 
ficial leeches  may  be  used  and  are  decidedly  prefer- 
able.    (Dch.) 

Hot  Douche: — Water  poured  into  the  meatus  will 
frequently  relieve  pain  at  once  w^hen  the  artificial 
leech  has  failed;  boric  acid  may  be  added,  ^ss-Oj. 
(Bac.)  Lucae's  douche  glass  may  be  conveniently 
used. 

Nitrate  of  Silver : — Applied  by  a  mop  to  the 
pharynx  is  of  benefit  v^hen  there  is  hyperaemia  in 
that  locality.  The  strength  of  the  solution  for  chil- 
dren should  be  10  to  15  grains  to  the  ounce,  for 
adults  15  to  20  to  the  ounce.  The  Politzer  may  also 
be  used  occasionally.     (Bck.) 

Steam  : — Introduced  into  the  ear  is  an  excellent 
method  of  applying  heat ;  care  must  be  exercised 
that  it  is  not  too  hot.     (Str.) 


426         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Carbolized  Glycerine : — 10  to  20  per  cent,  warm 
instillations  are  attended  with  good  results.  (T., 
97.) 

Menthol  Gauze  : — Impregnated  with  10  to  15  per 
cent,  solution  in  oil,  and  inserted  into  the  meatus  for 
twenty-four  hours  at  a  time,  has  been  used  with 
good  results.     (T.,  97.) 

Inflation  of  the  Ear  Drum : — May  be  employed  in 
less  severer  cases  with  slight  hyperaemia,  using  the 
Politzer  method  or  the  catheter.  The  former  should 
be  constantly  emplo3^ed  for  the  purpose  of  relieving 
accumulations  of  mucus  and  fluid,  for  the  restora- 
tion of  the  drum  to  its  proper  position,  and  to  pre- 
vent formation  of  adhesions.     (Bn.) 

Paracentesis : — If  in  spite  of  treatment  the  mem- 
brana  tympani  is  bulging  with  indications  of  per- 
foration, it  should  be  punctured  with  the  paracen- 
tesis needle  and  afterward  douched  with  a  solution 
of  boric  acid  or  bichloride  of  mercury,  1-4000.     (Bl.) 

CHRONIC  CATARRHAL  OTITIS  MEDIA. 

As  the  majority  of  cases  arise  from  lesions  of  the 
nose  or  vault,  treatment  should  first  be  directed  to 
those  localities.     (Bac.) 

The  patient  should  be  placed  in  the  best  hygienic 
surroundings,  guarding  against  changes  of  tempera- 
ture and  moisture  as  much  as  possible. 

Inflation  and  Catheterization : — When  there  is  hj-- 
pertrophy  and  hyperaamia  of  the  eustachian  tubes 
these  measures  are  indicated,  together  with  local 
treatment  to  the  naso-pharynx.  Bacon  states  that 
it  is  difficult  to  say  how  long  the  inflation  treatment 
should  be  continued.  In  most  cases  nothing  is 
gained    beyond  the  third   week,   and   on  the  other 


OTITIS   MEDIA.  427 

hand  improvement  may  not  begin  until  the  fifth 
week. 

All  manipulations  should  be  made  with  the  utmost 
gentleness.  When  the  catheter  is  in  position  it 
should  not  cause  pain.     (Str.) 

The  following  are  recommended  for  application  to 
the  pharyngeal  surfaces : 

Nitrate  of  Silver : — Applications  should  be  used  to 
the  vault  of  the  pharjmx  as  long  as  hj^perasmia  is 
recognizable  to  any  degree.  The  influence  of  the 
remedy  is  not  confined  to  the  actual  areas  of  appli- 
cation.    (Bac.) 


1^. 

M. 
Sig 

Potass.  lodidi, 

lodi, 

Glycerini, 

.     Appl}'  with  brush  in 
luents. 

old 

cases 

with 

gr.  X. 
gr.  V. 

glandular  enlarge- 

1*. 

Acid.  Tannici, 
Glycerini, 

3SS. 
5J. 

Aluminis. 
Glycerini, 

33s. 

M. 

Sig.     Appl}-  with  a  brush  in  acute  aggravations  with  a  tend- 
ency to  ulceration. 


Or, 


9;.    Fid.  Ext.  Hydrastis,  3j. 

Glycerini,  ^j. 


M. 

Or, 


?fc.    Pini  Canadensis,  3j. 

Glycerini,  |j. 

M.  (Str.) 


428  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

The  following  is  recommended    as  serviceable  in 
offensive  cases : 


9;.    lodoformi, 

gr.  X, 

Acid.  Tannici, 

gr- J- 

Sac.  Lactis, 

3iss. 

M. 

Sig.     Apply  with  a  powder  blower. 

(Str.) 

Injection  of  vapors  or  liquids  into  the  tympanum 
through  the  eustachian  tube,  according  to  modem 
writers,  has  not  been  attended  w^ith  satisfactory  re- 
sults. Of  the  operative  procedures  excision  of  the 
drum  head  and  the  two  larger  ossicles  appears  to  be 
the  most  satisfactory.     (Bn.) 

Hot  Air  Douches : — This  novel  treatment  has  re- 
cently been  introduced  by  Dr.  E.  L.  Vansant,  of  Phil- 
adelphia, w^ho  reports  very  successful  results  from  its 
use  in  cases  of  deafness  and  tinnitus  aurium  caused 
by  middle  ear  catarrh,  also  in  persistent  headache 
arising  from  catarrh  of  the  frontal  sinus.  The  use  of 
this  method  requires  an  especially  devised  instru- 
ment, w^hich,  together  with  the  technique  of  its  appli- 
cation, is  described  by  the  inventor  as  follows :  It 
consists  of  a  SA^ringe  containing  a  small  chamber,  in 
some  instances  holding  a  piece  of  carbon,  in  other 
instances  having  in  its  interior  several  diaphragms 
of  metal.  This  chamber  is  held  over  a  flame,  prefer- 
ably that  of  a  spirit-lamp,  until  heated.  Coming  off 
of  the  chamber,  anteriorly,  is  a  nozzle  wnth  adjust- 
able tips.  The  air  enters  the  chamber  from  behind 
and  is  heated  while  passing  through.  The  instru- 
ment is  small  in  size  and  is  held  by  a  handle  placed 
at  a  convenient  angle.  The  air  to  be  heated  is 
obtained  from  the  usual  air-condenser.  The  amount 
of  heat  produced  may  be  varied  at  w^ill,  from  a  mild 


OTITIS  MEDIA.  429 

-w^armth  to  a  burning  degree,  and  depends  upon  how 
hot  the  chamber  is  heated,  how  swiftly  the  current 
of  air  is  passed  through,  and  how  close  the  nozzle  is 
held  to  the  surface  to  be  treated.  In  some  instances 
vapors  of  chloroform,  menthol,  etc.,  have  been  added 
to  the  heated  air;  this  is  done  by  placing  a  small 
quantit3^  of  the  medicament  in  the  little  cup  found  on 
one  of  the  tips,  or  by  placing  it  direct  in  the  catheter, 
w^hen  one  is  used. 

In  preparing  the  nasal  chambers  for  treatment,  the 
mucosa  is  first  shrunken  by  applications  of  cocaine 
or  eucaine,  used  alone  or  followed  bj-  watery  solu- 
tions of  the  suprarenal  capsule  of  the  sheep. 

The  hot  air  is  directed  against  the  openings  of  the 
sinuses,  or,  if  necessary,  a  small  catheter  is  used. 
When  the  middle  ear  is  treated,  the  air  is  passed 
through  a  eustachian  catheter. 

The  treatment  when  properlj^  carried  out  is  said  to 
be  free  from  pain  and  rather  agreeable  to  the  patient. 
(P.  M.  J.,  9,  9,  99.) 

ACUTE  PURULENT  OTITIS  MEDIA. 

Severe  cases  should  be  confined  to  bed  and  the 
measures  recommended  for  the  acute  catarrhal  form, 
such  as  anodyne  instillations,  hot  w^ater  douches, 
local  depletion,  and  paracentesis  are  indicated. 

Heat: — Dr}^  heat  affords  relief  of  pain,  especially  in 
the  first  stage.  It  ma^^  be  applied  in  the  form  of  hot 
bran,  hot  salt,  or  hot  water  bag.  Moist  heat  may 
be  conveniently  emplo3'ed  by  filling  the  upturned  ear 
w^ith  water  at  a  temperature  of  105°,  and  appl3dng 
immediately  a  hot  flaxseed  poultice,  w^hich  in  turn  is 
covered  with  flannel.  Douching  the  ear  with  hot 
water  for  ten  minutes  at  a  time  is  another  method. 


430  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

but  is  not  as  convenient,  and  is  no  more  effective 
than  the  above.     (Bac.) 

Cold: — Leiter's  coil  constitutes  the  most  effective 
mode  of  appljang  this  agent,  which  is  especially  indi- 
cated when  symptoms  of  mastoid  inflammation  are 
impending.     (Dch.) 

Artificial  Leech: — If  the  patient  is  seen  in  the  early 
or  hyperaemic  stage,  inflammation  can  frequently  be 
arrested  by  the  application  of  the  artificial  leech, 
either  Burnett's,  Heurteloup's,  or  Bacon's.  These 
contrivances  are  vastl3^  superior  to  the  ordinary 
leech.  Thc}^  should  be  applied  in  front,  and  below 
the  tragus.     (Bck.) 

The  following  anodyne  will  also  be  found  useiul  for 
the  relief  of  pain  in  the  earlier  stages : 

9^.    Atrop.  Sulphatis,  gr.  i;. 

Acid.  Borici,  gr.  x. 

Aq.  Destill.  5j. 

M. 

Sig.     First  warm  and  then  drop  into  the  meatus  and  insert  a 
bit  of  cotton. 

Morphine,  Atropine,  and  Cocaine,  as  mentioned 
in  the  acute  catarrhal  form,  may  be  instilled  for  the 
relief  of  pain. 

Paracentesis: — The  ear  should  be  frequently^  exam- 
ined, and  soon  as  bulging  of  the  ear  drum  is  dis- 
covered, which  usually  occurs  in  the  posterior  half, 
the  membrane  should  be  relieved  w^ith  a  paracentesis 
needle.  (Str.)  After  this  it  may  be  necessary  to  force 
out  the  secretion  by  the  Politzer  method.  This 
should  be  done  frequently  during  the  course  of  the 
disease,  very  gently  w^hen  there  is  pain  and  more 
forcibly  as  the  acute  symptoms  subside.  After  para- 
centesis, the  discharge  should  be  promoted  with  the 
ear  douche  as  in  acute  catarrhal  otitis  media.  (Br.) 


OTITIS   MEDIA.  431 

Boric  Acid: — A  saturated  solution  warmed  and 
dropped  into  the  ear  several  times  a  day  after 
thorough  cleansing  of  the  canal  may  be  used  with 
benefit  after  the  acute  symptoms  have  begun  to 
abate.     (Bn.) 

Argonin  : — For  acute  purulent  inflammation  of  the 
middle  ear,  has  recenth'  been  recommended.  Its 
application  and  the  advantage  which  it  possesses 
over  boric  acid,  for  v^hich  it  appears  to  be  presented 
as  a  substitute,  may  be  summarized  as  follows : 
Argonin  solutions  are  highh'  antiseptic,  boric  acid 
less  so ;  they  can  be  forced  through  a  small  perfora- 
tion in  the  drum-head,  thus  reaching  every  part  of 
the  tympanic  and  eustachian  tubes.  In  such  cases 
boric  acid  lies  inactive  in  the  external  auditor3' canal. 
The\'  can  be  used  to  flush  the  middle  ear  and  tube, 
thus  reaching  every  part  of  the  inflamed  tract,  carry- 
ing out  with  it  all  products  of  inflammation,  and 
especialh'  relieving  the  attendant  fever  and  pain; 
argonin  excites  a  positive  and  decided  effect  upon 
the  suppurative  process.  Boric  acid  possesses  this 
pow^er  but  feebl}' ;  argonin  stimulates  the  closing  of 
the  perforations  in  the  drum-head.  Boric  acid  has 
no  such  action. 

To  obtain  these  effects  it  is,  of  course,  necessary 
that  the  solution  (2  to  5  per  cent.)  should  pass 
through  the  middle  ear,  in  order  that  it  may  be 
brought  into  contact  w^ith  the  w^hole  of  the  mem- 
brana  tympani.  This  is  usually  not  difficult.  Hav- 
ing cleansed  the  canal  in  the  usual  manner,  say  v^nth 
carbolized  water  or  a  solution  of  hydrogen  peroxide, 
the  drum  cavity  is  to  be  emptied  by  Valsalva's 
method,  or  by  the  Politzer  bag,  and  the  secretion 
thus  blo\vn  out  removed  with  the  cotton  carrier. 


432  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

The  auditory  canal  is  then  filled  with  the  argonin 
solution,  and  while  covering  the  outer  end  of  the 
canal  with  the  tragus,  at  the  same  time  making 
strong  pressure  upon  it,  the  solution  is  forced 
through  the  perforation  into  the  middle  ear,  thence 
to  the  throat  by  way  of  the  eustachian  tube.  The 
application  is  entirely  painless.     (T.  C.  R.,  6,  98.) 

For  antisepsis  and  cleanliness,  solutions  of  Forma- 
lin, Bichloride  of  Mercury,  Hydrogen  of  Peroxide, 
Carbolic  Acid,  Creolin,  etc.,  as  mentioned  under  the 
chronic  purulent  form,  wall  be  called  for.  Boyle  uses 
the  following  with  good  effect : 

Formalin,  gtt.  iij. 

Hydrogen  Peroxide, 

Boric  Acid,  Saturated  Solution,  aa  ^ss. 

A  few  drops  in  the  ear  every  two  hours. 

Powders:  —  Remedies  in  this  form  are  of  service 
when  the  perforation  is  large  and  the  inflammatory 
symptoms  have  not  been  severe.  The  same  pow- 
ders mentioned  for  use  in  the  acute  catarrhal  form 
are  also  indicated  in  this  variety.  When  the  dis- 
charge is  profuse  and  contains  considerable  mucus, 
remedies  in  this  form  should  not  be  used. 

Astringent  Injections: — Are  indicated  in  place  of 
pow^ders  w^hen  there  is  profuse  mucous  discharge, 
viz.:  Sulphate  of  Zinc,  Acetate  of  Lead,  Sulphate  of 
Copper,  all  in  the  proportion  of  gr.  ij-iv-^j.     (Bn.) 

Injections  of  \A^arm  Water  through  the  catheter 
into  the  middle  ear  are  recommended  in  cases  when 
pain  continues  uninterruptedly  after  perforation  of 
the  membrana  tympani  in  obstinate  forms  and  in 
painful  inflammation  of  the  mastoid  process.     (Fid.) 

Tr.  Iron  Chloride  on  a  probe,  Nitrate  of  Silver  or 
fused  Chromic  Acid  used  with  extreme  caution  may 


OTITIS  MEDIA.  433 

be  applied  to  the  granulations  which  form  on  the 
edges  of  the  perforation  or  in  the  middle  ear.  If 
chromic  acid  is  used  especial  care  must  be  taken  to 
touch  nothing  but  the  granulation.     (Bck.) 

The  pharynx  should  receive  treatment  with  sooth- 
ing sprays  during  the  course  of  the  disease. 

CHRONIC    PURULENT   OTITIS    MEDIA— OTOR- 
RHCEA. 

Antisepsis  and  asepsis  must  be  maintained.  Some 
aurists  prefer  using  a  syringe,  others  mop  out  the 
discharge  with  absorbent  cotton  on  a  cotton  holder, 
then  the  whole  external  auditory  canal  and  its 
fundus  is  cleansed  wdth  cotton  soaked  in  an  anti- 
septic fluid,  which  is  squeezed  out  into  the  parts. 

The  following  solutions  are  recommended  for  this 
purpose,  to  be  used  Avarm : 

Formalin,  1-2000-1000. 

Carbolic  Acid,  1-40. 

Mercuric  Bichloride,  1-4000-3000. 

Salicylic  Acid,  gr.  iij— 5J. 

Creolin,  1-1000. 

Hydrogen  Peroxide: — If  the  discharge  is  verj^  thick 
a  solution,  12  per  cent.,  may  be  slowdy  instilled,  ap- 
plying a  few  drops  at  a  time  until  effervescence 
ceases.  This  remedy,  of  course,  cannot  be  heated, 
and  therefore  must  be  used  at  the  temperature  of  the 
atmosphere.  (Str.)  When  the  discharge  is  profuse, 
cleanse  with  the  peroxide  every  two  hours  and  dry 
thoroughly  with  absorbent  cotton.     (Bl.) 

After  cleansing,  the  ear  should  be  carefully  exam- 
ined for  granulations,  polypi,  denuded,  carious,  or 
necrotic  spots  in  the  bony  parts,  which  if  present 
should  receive  appropriate  treatment.  When  asepsis 
29 


434  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

has  been  established  it  should  be  maintained  b^-  ap- 
plications daily,  or  everv^  other  day,  as  the  nature 
and  quantity  of  the  discharge  indicate.  For  this  pur- 
pose the  antiseptic  solutions  mentioned  may  be  em- 
ployed with  a  mop  or  in  the  form  of  one  of  the  fol- 
lowing powders,  the  latter  are  generally  regarded  as 
superior,  as  the  parts  are  thereby  rendered  aseptic 
more  continuously. 

Boric  Acid: — Pure,  or  Calendulated  or  mixed  with 
Plantago;  the  latter  is  prepared  thus:  1  part  of  sugar 
of  milk  is  mixed  with  fluid  extract  of  plantago,  as 
much  being  added  as  will  thoroughly  moisten  the 
sugar;  triturate  this  in  a  mortar,  and  add  equal 
parts  of  boric  acid ;  this,  according  to  Houghton, 
gives  better  results  than  the  acid  alone. 

An  effective  preparation  is  as  follows : 

^.    lodoformi,  gr.  ix. 

Acid.  Tannici,  gr.  j. 

Sac.  Lactis,  gr.  xc. 
Triturate  thoroughly.  ( Str. ) 

Resorcin,  Aristol,  Dermatol,  pure  or  mixed^with 
Boric  Acid  and  Hydrastinated  Boric  Acid,  are  rec- 
ommended.   Airol  has  also  been  used  successfulh\ 

Oil  of  Eucalyptus: — 1  part,  vaseline  8  parts,  ap- 
plied on  cotton,  acts  especiall3^  well  in  offensive 
cases.  The  patient  ma\'  also  use  at  night  three  or 
four  drops  applied  on  a  piece  of  twisted  cotton. 
(Str.) 

Various  astringent  solutions  are  also  used,  viz.: 

Zinc  Sulphate,  gr.  ij-5J. 

Zinc  Sulpho-Carbolate,  gr.  v-gj. 

Glycerite  of  Tannin. 

*NoTE. — Both  boric  acid  and  iodoform  have  a  tendency  to  cake 
in  the  ear,  hence  some  caution  is  necessary  in  their  use. 


PARALYSIS.  435 

Nitrate  of  Silver,  gr.  j-x-§j. 

Acetate  of  Lead,  gr.  ij-5J. 

Cadmium  Sulphate,  gr.  ij-5j.  More  astringent  at 
the  same  time  more  irritating  than  zinc. 

Treatment  by  antiseptic  powders  or  instillations 
should  be  appled  daily  for  a  few  days ;  then  every 
other  day,  and  at  longer  intervals  as  the  discharge 
lessens.  If,  after  a  month  or  two,  benefit  is  not  ob- 
served, the  mucous  membrane  of  the  drum  cavity 
granulating  or  swollen,  drainage  defective,  and  the 
malleus  or  any  part  of  the  tympanic  \valls  carious, 
the  membrana  tympani,  the  malleus  and  the  incus 
should  be  removed  by  excision.     (Burnett.) 

The  granulations  which  may  follow  chronic  sup- 
puration of  the  middle  ear  usually  disappear  under 
treatment  by  antiseptic  powders,  but  if  such  is  not 
the  case  the  following  may  be  used :  Alcohol  alone 
or  mixed  with  equal  parts  of  Boric  Acid  and  water, 
Potassium  Bichromate,  saturated  solution,  or 
Chromic  Acid,  applied  by  means  of  a  probe  dipped 
into  the  deliquescent  crystals.  The  application 
should  be  made  w^ith  great  care  and  under  illumina- 
tion. 


OZJENA. 

See  Atrophic  Rhinitis. 

PARALYSIS. 

Electricity: — Widely  used  in  the  various  forms;  in 
apoplectic  paralysis  it  is  often  proposed,  but  the  re- 
sults are  not  encouraging.  In  these  conditions  it 
should  not  be  applied  too  soon  after  the  seizure,  and 


436  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

\^^hen  applied  to  the  head  at  least  a  month  should 
have  elapsed. 

Electrical  treatment  is  much  the  same  for  all  forms 
of  cerebral  paralysis  varj^ng  only  with  the  seat  of 
lesion  and  the  muscles  affected,  (Rk.)  Galvanism 
and  faradism  are  both  emploj^ed.  De  Watte ville's 
method  in  hemiplegia  is  to  apply  a  large  electrode  to 
the  nape  of  the  neck  and  the  other,  also  large,  on  the 
diseased  side  so  as  to  include  the  seat  of  lesion  be- 
tween the  two.  In  hemiplegia  the  constant  current 
maj^  be  applied  to  the  brain  to  improve  its  nutrition 
and  the  faradic  to  the  muscles  to  prevent  atrophy 
and  loss  of  function.  (Bw.)  If  the  muscles  are  weak 
and  flabb}'  much  improvement  will  follow  faradiza- 
tion. A  current  just  strong  enough  to  cause  contrac- 
tion should  be  used.  The  muscular  contractions 
w^hich  ensue  after  a  time,  and  which  appear  princi- 
pally in  the  forearm  and  hands,  may  be  treated  by 
the  continuous  current  to  the  flexors  and  an  inter- 
rupted or  faradic  current  to  the  extensors.     (B.) 

In  lead  paralysis,  if  the  muscles  fail  to  respond  to 
faradization  and  react  v^hen  stimulated  by  a  slowly 
interrupted  galvanic  current,  the  interrupted  gal- 
vanic current  maj'  be  first  employed  followed  b^^  the 
faradic  w'hen  the  muscles  have  so  far  improved  as  to 
respond  to  the  latter. 

For  facial  paralysis  the  positive  pole  should  be 
placed  on  the  pes  anserinus  or  on  the  mastoid  pro- 
cess and  the  negative  is  passed  over  the  peripheral 
expansion  of  the  nerve,  so  that  all  the  enervated 
muscles  may  be  stimulated  to  contract.  A  current  of 
sufficient  strength  to  produce  muscular  contraction 
should  be  employed. 

In  paralysis  of  spinal  origin,  electricity-  will  often 


PARALYSIS.  437 

give  excellent  results,  but  not,  hov^'ever,  in  all  forms. 
In  the  infantile  variety  treatment  should  begin 
early,  but  not  until  after  the  inflammatory  symp- 
toms have  disappeared.  Good  results  are  obtained 
by  galvanism  and  faradism  of  the  paralyzed  muscles, 
as  well  as  galvanization  of  the  spinal  nerves  and 
plexus.    (B.) 

*  Chapman's  System  of  Applying  Heat  and  Cold 
to  the  Spine: — Though  applicable  to  other  diseases 
this  method  finds  an  important  sphere  of  action  in 
paralysis.  A  knowledge  of  the  anatomy  and  physi- 
ology of  the  vaso-motor  nervous  system  is  necessary 
for  its  successful  employment. 

To  apply  heat  and  cold,  which  are  the  essentials  of 
the  treatment,  rubber  bags  are  used.  The  apparatus 
for  hot  water  consists  of  two  narrow  bags  8  to  10 
inches  long  kept  parallel  by  cords  or  straps,  the  in- 
tention being  to  direct  the  heat  upon  the  sides  rather 
than  the  centre  of  the  spine.  For  emergencies  a  yard 
of  flannel  8  to  10  inches  wide  rolled  from  both  ends 
nearh'  to  the  middle  wall  answer.  These  parallel 
flannel  rolls  are  to  be  dipped  in  hot  water  115°  to 
120°  F.  and  applied.  Other  excellent,  substitutes  are 
Edison's  electro-therm,  the  Japanese  hand-warmer, 
hot  salt  or  sand,  or  lime  w^hile  slaking  in  flat  metal 
boxes. 

Chapman's  ice  bag  has  no  open  space  like  the  hot 
water  bag,  as  it  must  cover  the  spine  itself  as  well  as 
its  sides  ;  it  is  10  to  18  inches  long  and  about  4  inches 
wide,  narrower  for  children  and  wader  for  very  large 
persons.     Usually  there  are  three  compartments,  but 

*  Condensed  by  Dr.  Jas.  Robie  Wood,  from  his  clinics  at  the 
Metropolitan  Hospital,  Blackwell's  Island,  New  York,  and  espe- 
cially prepared  by  him  for  this  work. 


438  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

they  are  not  absolutely  necessar3\  To  prevent  leak- 
age the  bag  is  securely  tied  or  clamped  at  the  top. 
When  such  a  bag  cannot  be  procured,  an  ox's  gullet 
or  a  section  of  gut  from  an^^  animal  can  be  substi- 
tuted. Chemical  refrigerants  maA'  supply  the  place 
of  ice. 

The  ideas  in  the  application  of  heat  and  cold  to  the 
spine  are  simply-  these :  To  contract  arteries  which 
are  controlled  from  certain  nerve  centres  heat 
should  be  placed  close  to  those  spinal  centres;  this 
stimulates  the  vaso-constrictor  nerve  fibres  and 
through  them  diminishes  the  calibre  of  arteries 
w^ithin  their  influence. 

Applied  upon  the  same  region  the  action  of  cold  is 
directly  opposite ;  by  reducing  the  circulation  within 
and  near  the  spinal  column  it  parth'  paralyzes  the 
vaso-constrictor  filaments  which  supply  the  muscu- 
lar walls  of  blood  vessels,  thereby  permitting  more 
or  less  dilatation  of  the  arteries  under  their  control. 

To  make  use  of  this  knowledge  it  must  first  be  as- 
certained whether  arterial  narrowing  or  widening  is 
demanded  in  any  given  disease,  in  other  words,  con- 
ditions are  the  first  consideration.  For  instance,  in 
the  same  malady  anaemia  or  hyperaemia  of  the  brain 
may  occur.  Now  in  cerebral  anaemia,  if  an  ice  bag  be 
applied  over  the  lumbar  and  dorsal  vertebras,  that 
part  of  the  spinal  cord  having  no  direct  influence 
upon  blood  vessels  within  the  cranium,  the  cold  by 
causing  dilatation  of  the  small  arteries  of  the  abdo- 
men and  legs  would  produce  a  rapid  fall  in  blood 
pressure  and  syncope  might  result. 

On  the  contrary,  heat  upon  the  same  locality,  by 
inducing  contraction  of  arteries  in  the  legs  and  abdo- 
men, would  increase  the  flow  of  blood  to  the  brain. 


PARALYSIS.  439 

In  cerebral  hypersemia  cold  over  the  same  vertebras 
\vould  relieve  cerebral  congestion,  while  heat  would, 
intensify  that  congestion.  At  the  ver\'  onset  of  apo- 
plexy, in  many  cases,  the  dorso-lumbar  application 
of  an  ice  bag  wall  control  the  cerebral  circulation  so 
as  to  prevent  prolonged  coma,  and  not  infrequently 
consciousness  will  be  restored  within  a  few  hours. 

In  the  cases  of  paral3^sis  presented  at  this  clinic  to- 
day you  have  an  opportunity  of  seeing  the  marked 
benefits  of  Chapman's  system  of  treatment.  None  of 
these  patients  has  had  more  than  one  hour's  applica- 
tion of  ice  each  day ;  such  chronic  cases  generally  re- 
quire two  or  three  hours'  treatment  daily.  This  old 
woman  has  had  two  attacks  of  apoplex3^  and  has 
been  paralyzed  on  one  side  for  eight  months.  With- 
out assistance,  other  than  a  cane,  she  has  walked 
do\vn  stairs  to  present  herself  at  this  clinic  after  four 
weeks'  dorso-lumbar  ice  applications  and  an  occa- 
sional laxative,  which  latter  is  ver^^  important  dur- 
ing treatment  at  least  once  or  twdce  a  week. 

Here  is  a  patient  w^ith  both  low^er  extremities  par- 
alyzed and  atrophied  from  spinal  disease.  Her  most 
distressing  sj^mptom,  constant  involuntary  dis- 
charge of  urine  and  faeces,  one  \veek  after  the  first 
dorso-lumbar  ice  application  was  under  complete 
control.  In  other  respects  she  has  not  as  yet  im- 
proved. 

Let  me  mention  a  few^  of  the  many  maladies  in 
which  the  ice  bag  applied  upon  the  dorso-lumbar 
region  wnll  be  more  or  less  palliative,  if  not  alw^ays 
curative,  when  the  proper  conditions  are  present. 
They  are  acute  and  chronic  cerebral  and  spinal  con- 
gestions and  inflammations,  cerebral  and  spinal  apo- 
plexy, immediate  or  threatened  sunstroke  with  cere- 


440         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

bral  congestion ;  paralysis  from  various  causes,  to 
suppl}^  nutrition  w^hen  nerve  degeneration  is  not  too 
far  advanced ;  spasmodic  diseases,  such  as  epilepsy 
and  some  forms  of  general  convulsions  ;  painful  spas- 
modic affections  dependent  upon  irritation  of  some 
portion  of  the  spinal  cord ;  spasmodic  contraction 
of  muscles ;  atrophied  muscles  and  organs ;  trismus 
and  tetanus  ;  angina  pectoris ;  locomotor  ataxia ; 
neuralgia ;  neuritis  and  neurasthenia ;  headaches, 
especially  those  from  grief,  mental  and  phj^sical  ex- 
haustion and  alcoholism;  many  hysterical  condi- 
tions ;  dysmenorrhcea,  particularly  w^hen  compli- 
cated with  headache ;  amenorrhcea  with  or  wdthout 
maniacal  symptoms ;  insomnia ;  during  chill  of  in- 
termittent fever ;  cold  feet ;  gastric  disorders ;  con- 
stipation ;  sporadic  and  Asiatic  cholera ;  chronic 
diarrhoea ;  obstinate  nausea  and  vomiting,  espe- 
cially seasickness ;  eczema  and  some  serious  troubles 
of  the  eye. 

Heat  may  be  applied  to  the  dorso-lumhar  region  in 
diseases  attended  with  cerebral  anaemia;  the  hot 
stage  of  intermittent  fevers  ;  congestions  and  inflam- 
mations in  various  abdominal  diseases,  such  as  me- 
tritis, peritonitis,  enteritis,  nephritis,  and  cystitis ; 
haemorrhages,  uterine,  intestinal,  renal,  cystic,  and 
gastric. 

Heat  may  be  applied  over  the  middle  and  upper 
dorsal  vertebrae  for  pulmonary  haemorrhages,  con- 
gestions and  inflammations,  except  when  its  action 
might  impede  the  circulation  of  the  heart  and  lungs 
by  intensifying  an  already  existing  arterial  constric- 
tion, a  condition  in  which  amyl  nitrite,  sodium 
nitrite,  or  nitro-glycerine  would  be  indicated.  In 
such  cases,  heat  betw^een  the  shoulders  ^vould  be 
harmful. 


PARALYSIS.  441 

Heat  may  be  applied  to  the  cervical  vertehrse  in 
various  congestions  and  inflammations  of  organs, 
glands  and  other  tissues  that  are  suppHed  by  nerve 
filaments  from  the  cervical  sympathetic.  Cold  may 
be  applied  to  the  same  region  where  anaemia  or  de- 
generation exists  in  those  organs,  glands  and  tissues. 

Where  to  place  the  bags.  The  ice  bag  must  not 
reach  below  the  last  lumbar  vertebra,  except  in  rare 
conditions  to  control  the  nervi-erigentes.  A  conve- 
nient rule  is  to  place  its  lower  end  on  a  line  with  the 
crest  of  the  ilia.  Thence  let  it  extend  to  the  middle 
or  upper  dorsal  vertebrse,  according  to  the  extent  of 
the  lesions. 

Cautions.  The  bag  of  ice  must  be  prevented  from 
slipping  to  the  sides  lest  an  annoying  cold  be  de- 
veloped. It  is  not  well  to  apply  ice  immediately 
after  a  meal  or  while  freely  perspiring.  The  same 
care  is  not  needed  w^ith  the  hot  w^ater  bag,  which 
may  be  placed  at  any  indicated  point  along  the 
spine.  Do  not  persist  in  applying  ice  when  it  be- 
comes disagreeable  and  the  patient  feels  chilled;  in 
such  cases  suspend  the  ice  and  administer  laxatives, 
or  apply  heat  on  the  same  place.  Where  very  rapid 
action  is  demanded  to  constrict  the  blood  vessels  in 
the  upper  part  of  the  body  or  head  and  to  dilate 
those  of  the  abdomen  and  legs  at  the  same  time,  the 
hot  water  ma3''  be  placed  upon  the  upper  dorsal  and 
cervical  vertebras,  w^hile  the  ice  bag  is  at  the  same 
time  placed  upon  the  lumbar  and  lov^er  dorsal  verte- 
brae. 

You  will  be  better  guided  by  keeping  in  mind  these 
statements  of  Chapman : 

1st.  ^^ By  the  spinal  application  of  cold  muscular 
tension  is  diminished ;   sensibilitv  is  lessened,  secre- 


442  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

tion  is  lessened ;  the  peripheral  circulation,  and,  con- 
sequentU',  bodily  heat  is  increased." 

2.  '*  By  the  spinal  application  of  heat  muscular 
tension  is  increased,  sensibility  is  increased,  secretion 
is  increased;  the  peripheral  circulation,  and,  there- 
fore, animal  heat,  is  lessened." 


PAROTIDITIS— MUMPS. 

Cotton  batting  as  a  covering  is  all  that  is  usually 
necessary  in  simple  cases.  There  should  be  no 
counter-irritation.     (C.) 

Cold  Cream  or  Vaseline: — Is  often  applied,  and 
may  possibly  allay  the  sensation  of  tension. 

Belladonna  or  Phytolacca  Ointments:  —  May  be 
employed  in  conjunction  with  the  same  remed\'  in- 
ternally.    (Ha.) 


PEDICULOSIS. 

PEDICULOSIS  CAPITIS. 

The  most  expeditious  measure  is  shaving  the  hair, 
and  the  application  of  some  emollient  for  the  eczema, 
which  is  usually  present.  This,  however,  is  onl^'  ad- 
visable in  the  case  of  children  and  men  in  hospitals, 
but  it  is  generallj^  unnecessary,  for  the  proper  use  of 
antiparasitics  w^ill  accomplish  the  desired  end. 
The  following  w^ill  prove  satisfactorj' : 
Staphisagria: — Much  used,  and  is  generally  effect- 
ive.    The  decoction  or  tincture  may  be  applied  pure, 


PEDICULOSIS.  443 

or  the  fluid  extract  diluted  with  vinegar ;  1  drachm 
to  the  ounce  of  vinegar.  (Al.)  Another  preparation 
is  made  by  macerating  an  ounce  of  the  seeds  in  a 
pint  of  vinegar.     (F.) 

Kerosene  Oil: — A  remedy  suitable  for  dispensary 
practice.  Saturate  the  scalp  and  allow  the  oil  to  re- 
main on  over  night,  apply  for  tw^o  days,  then  v^'^ash 
the  head  thoroughly  with  soap  and  water.  It  will 
kill  the  pediculi  but  not  the  nits.  In  applying  the  oil 
avoid  letting  it  inin  down  over  the  face  and  neck  for 
fear  of  causing  excoriation. 

Vinegar: — Will  kill  and  loosen  the  nits  and  there- 
fore should  supplement  the  application  of  kerosene. 

(F.) 
Cocculus   Indicus: — The  tincture  or  decoction,  is 

effective  both  for  pediculi  and  nits.     (F.) 
Startin  recommended 


^.    Sod.  Hj'posulphatis, 

Sij- 

Acid.  Sulphurosi  Dil., 

3iv. 

Aquae, 

q.  s.  ad  5xvj 

M. 

Sig.     Apply  once  daily. 

The  following  are  useful : 

Hydrarg.  Bichlorid.,  gr.  iij-v-§j. 

Carbolic  Acid,  gr.  iij-iv,  alcohol,  .^j. 

,S-Napthol,  5  per  cent,  in  oil. 

When  the  hair  is  short,  ointments  may  be  employed 
advantageously,  viz.: 

Ammoniated  Mercury,  gr.  xx-3j-^j. 

Staphisagria  Seeds,  in  powder,  3j,  lard,  5j. 

Carbolic  Acid,  gr.  xv-xxv,  ung.  petrolei,  |j;  this  is 
most  effective. 


44-4  DIGEST   OF   EXTERXAI.   THERAPEUTICS. 

PEDICULOSIS  CORPORIS. 

Administer  a  Hot  Bath  with  plentj^  of  soap  and 
boil  or  bake  the  clothing.  When  this  is  not  prac- 
ticable, iron  the  seams  to  destroy  parasites  and  ova. 
After  the  bath  use  inunctions,  viz.: 

Staphisagria: — The  powdered  seed  .^ij,  lard,  sj  (Vn.), 
or  the  oil,  sj,  ^vith  Ammoniated  Mercury, ^iij,  lard  to 
5j.     (T.,96.) 

Carbolic  Acid  : — Useful  in  various  combinations, 
viz.: 

9:.    Acid.  Carbolici,  3J~^J- 

Glycerini,  3j. 

Aquae,  Oss. 

M.  Sii. 

Paraffine  Oil: — Said  to  be  the  most  certain  and 
speedy  remedy. 

Sulphur: — A  small  piece  about  the  size  of  a  pigeon's 
egg  may  be  worn  next  to  the  skin  night  and  day. 

The  remedies  for  pediculosis  capitis  are  also  of  use 
in  this  condition. 

PEDICULOSIS  PUBIS. 

The  parts  should  be  washed  with  soap  and  water 
daily  and  the  remedy  applied  for  some  daj'S  to  in- 
sure the  destruction  of  the  ova.  Effective  applica- 
tions are  as  follow^s : 

Hydrarg.  Bichlorid.,  gr.  ij-iv,  alcohol  or  water,  §j. 

Ung.  Hydrarg.  Oleati,  10  to  20  per  cent. 

Ung.  Hydrarg,  Ammoniati. 

Naphthol,  5  to  10  per  cent,  solutions.     (F.) 

The  folloAving  other  agents  are  also  useful : 

Ointments  of  Veratrine,  Sabadilla  Seeds,  ,J-Naph- 
thol,  10  percent.,  Losophen,  10  to  20  per  cent.,  Oil 


PELVIC  INFLAMMATION.  4>45 

of  Rosemary,  solution  of  Creoline,  about  2  per  cent. 
Balsam  Peru  with  olive  oil,  equal  parts ;  apply  for 
three  or  four  days  before  washing. 


PELVIC  INFLAMMATION. 

ACUTE  PELVIC  INFLAMMATION. 

In  view  of  the  intimate  anatomical,  pathological, 
and  clinical  association  of  the  uterine  appendages, 
and  of  the  similarit3^  of  the  external  remedial  meas- 
ures which  are  employed  for  the  relief  of  morbid  con- 
ditions in  these  parts,  salpingitis,  oophoritis,  pelvic 
cellulitis,  and  pelvic  peritonitis  w^ill  be  considered  col- 
lectively. 

Rest  in  bed.  Hot  Fomentations  over  the  hj^pogas- 
trium  (K.  C),  careful  antisepsis  of  the  vagina,  and 
prolonged  vaginal  Douches  of  hot  water  as  in 
acute  metritis .     ( Pz . ) 

Cold: — In  the  form  of  an  ice  bag,  wall  be  found  ser- 
viceable in  some  cases.     (Dud.) 

For  the  relief  of  pain  small  Blisters  over  iliac  re- 
gion, followed  by  the  application  of  Morphine  and 
painting  with  Iodine.  The  administration  of  ano- 
dyne injections  is  useful  for  oophoro-salpingitis.  If 
an  external  w^ound  is  the  source  of  infection,  it 
should  be  cauterized.     (Dud.) 

Operation  is  advised  at  the  moment  sepsis  ap- 
pears, viz..  Free  Opening  into  the  depth  of  the  in- 
flamed mass,  and  drainage.     (K.  C.) 

After  the  acute  symptoms  have  subsided  vaginal 


446  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

tamponade  should  be  employed,  as  in  chronic  endo- 
metritis. 

CHRONIC  PELVIC  INFLAMMATION. 

Treatment  is  generally  on  the  same  lines  as  in 
chronic  endometritis  and  metritis. 

Laparotomy: — Pozzi  says:  "That  whatever  maj' 
be  said  to  the  contrary,  a  laparotomy,  or  even  an 
exploratory^  incision,  is  not  justifiable  for  the  mere 
relief  of  persistent  pain  in  the  vicinity  of  the  append- 
ages."    Purulent  forms  demand  surgical  interference. 


PEMPHIGUS. 

The  blebs  are  to  be  punctured  and  evacuated  as 
soon  as  formed  and  the  parts  anointed  with  Zinc 
Oxide  Ointment. 

Soothing  and  astringent  lotions  and  dusting  pow- 
ders are  indicated,  especially  the  latter.  Of  the 
lotions.  Lime  Water,  Thymol,  1-1000,  solutions  of 
Borax,  Lotio  Nigra  and  Liq.  Plumbi  Subacetatis 
may  be  used  as  in  acute  eczema;  of  the  po-wders, 
Zinc  Oxide  and  Starch,  equal  parts.  Bismuth,  Lyco- 
podium,  and  Dermatol  have  proved  of  benefit. 

Tumenol : — 2  to  5  per  cent,  solutions  applied  with 
compresses  has  been  found  valuable,  also  an  oint- 
ment of  tumenol  oil  containing  from  5  to  10  per 
cent,  of  the  oil,  mingled  wath  5  per  cent.  Oxide  of 
Bismuth  and  Oxide  of  Lead,  with  lard  as  a  base. 

Baths  containing  Bran,  Starch,  or  Gelatine,  and 
in  some  cases  the  continuous  w^arm  bath  as  recom- 
mended bv  Hebra.     Corrosive  Sublimate  and  Alka- 


PERICARDITIS.  447 

line  baths  will  sometimes  prove  of  ser\dce.  (Pp.) 
After  the  baths,  dusting  powder  or  ointments  may- 
be applied. 

Hardaway  recommends  Lin.  Calcis,  1  ounce,  with 
Creosote,  1  minim. 

Unna  recommends  equal  parts  of  Linseed  Oil, 
Limie  Water,  Zinc  Oxide,  and  Chalk,  both  for  dry- 
ing and  for  preventing  the  formation  of  bullse. 

Ointments: — Are  sometimes  useful,  as  water  does 
not  always  agree.  The  following  may  be  used : 
Vaseline,  Rose  Water  Ointment,  Lanolin,  with  or 
without  5  to  10  per  cent,  of  Zinc  Oxide  or  Bismuth 
Subnitrate,  or  with  3  to  5  per  cent,  of  Ichthyol  or 
Sulphur  (Mor.),  Lassar's  Paste,  Zinc  Oxide  or 
Diachylon  Ointment.     (Ck.) 

(J-Naphthol: — A  10  per  cent,  ointment  is  useful  for 
the  itching. 

Europhen  : — Used  in  the  strength  of  10  per  cent,  is 
also  effective.     (T.,  98.) 

Ointments  should  be  spread  on  cloths  and  bound 
down  with  bandages. 

Nitrate  of  Silver: — Gr.  ij-5J,  was  employed  by 
Erasmus  Wilson  after  the  bullae  had  ruptured. 


PERICARDITIS. 

Prompt  treatment  is  of  the  greatest  importance. 
Rest  in  bed  is  absolutely  essential ;  under  no  circum- 
stances should  the  patient  be  permitted  to  leave  it. 

Hot  Applications: — Generally  grateful.  Poultices 
tend  to  relieve  pain,  and  by  dilating  the  superficial 


448  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

vessels  drain  the  deeper.  Their  use  should  be  confined 
to  the  first  stage  of  inflammation.  If  applied  in  the 
usual  way  they  will  be  too  hot,  and  if  of  the  proper 
temperature  at  the  time  of  application  the3^  will 
soon  cool  therefore,  apply  first  over  the  heart  a  thick 
flannel  and  over  this  the  poultice.  The  heat,  which 
now  will  not  bum,  may  be  maintained  for  a  much 
longer  period.     (Gn.) 

Morphia  and  Atropia: — Moderate  doses  of  these 
remedies  associated,  administered  hypodermically, 
are  very  satisfactory  for  the  relief  of  pain.  Morphia, 
Vi  grain ;  atropia,  y^^  grain.     (Ty.) 

Blisters: — Strongly  advocated  by  some  of  the  most 
recent  authorities,  to  be  applied  as  soon  as  diagnosis 
is  made.  A  blister  at  least  three  inches  square  is  to 
be  applied  over  the  praecordial  space.  There  is  no 
other  disease,  says  T^-son,  in  which  this  agent  gives 
more  satisfaction.  Compare  paragraph  on  this  sub- 
ject under  Acute  Endocarditis. 

Cold  Applications: — While  heat  is  generally  more 
grateful,  the  ice  bag  or  Leiter's  coil  are  eifective  in 
some  cases  affording  great  relief  and  apparently 
controlling  inflammation.  (Gn.)  Cold  sponging  or 
even  the  cold  pack  may  be  used  in  cases  attended 
with  intense  hyperpyrexia.     (L.  T.) 

Mercurial  Ointment: — This  is  highly  praised  by 
some  writers  as  effective  after  the  subsidence  of  acute 
symptoms.  It  is  used  throughout  the  stage  of  sub- 
acute inflammation.  It  may  be  applied  on  flannel 
under  oiled  silk.     (H.) 

Paracentesis: — If  effusion  is  considerable  immedi- 
ate [puncture  of  the  pericardial  sac  must  be  consid- 
ered. The  puncture  should  be  made  in  the  fourth 
interspace  one  inch  to  the  left  of  the  sternum,  first 


PERIOSTITIS  AND  OSTITIS.  449 

carefully  dividing  with  the  scalpel  the  skin  and 
underlying  tissues,  until  the  pericardium  is  reached, 
then  puncture  with  a  trocar.  When  the  effusion  is 
purulent  free  incision'may  be  made,  and  drainage  es- 
tablished, with  proper  antiseptic  precautions.     (Gn.) 


PERIOSTITIS  AND  OSTITIS. 

See  also   Nodes. 

In  the  acute  forms,  rest  in  bed  and  elevation  of  the 
parts ;  a  few  Leeches  over  the  inflamed  point  will  do 
much  to  relieve  pain.  This  may  be  followed  by  Hot 
Fomentations  or  Goulard's  Solution  with  Opium. 
(HI.) 

Compound  Mercurial  Ointment: — Applied  as  fol- 
lows frequently  has  a  beneficial  effect:  Spread  the 
ointment  on  lint  and  apply  it  all  around  the  limb. 
Then  straps  are  firmly  and  evenly  applied  from  some 
distance  above  to  some  distance  below  the  seat  of  in- 
flammation ;  over  the  w^hole  a  starch  or  gum  band- 
age is  placed.  Thus  pressure  as  well  as  the  action  of 
the  mercurv  are  obtained.     (HI.) 


PERITONITIS. 

Local  measures  for  the  reduction  of  inflammation 
do  not  play  a  very  important  role. 

Heat: — Most  useful  in  allaying  pain  and  may  be 
applied  in  the  form  of  a  hot  w-ater  bag,  flannel 
wrung  out  in  hot  crater  and  covered  with  oiled  silk, 
30 


450    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

or  light  flaxseed  poultices,  frequently  applied,  and 
covered  with  cotton  and  oiled  silk.  As  hot  water 
bags  are  generally  too  heavy  to  be  placed  over  the 
sensitive  abdomen  they  can  Ije  placed  at  the  sides 
and  assist  in  keeping  the  light  poultices  warm.  (Ty.) 

Cold: — In  the  form  of  compresses  is  preferred  In- 
some  writers,  who  claim  they  do  more  good  than 
hot  applications;  they  are  certainh'  preferable  in 
some  cases.  (Rd.)  Ice  bags  may  also  be  used  for 
the  relief  of  pain. 

Turpentine  : — Stupes  are  employed  for  the  relief  of 
tympanites;  flannels  are  wrung  out  in  hot  water 
and  sprinkled  v^ith  turpentine,  or  equal  parts  wnth 
sweet  oil,  using  about  2  drachms  of  the  mixture, 
which  may  be  spread  on  poultices.     (L.  T.) 

Counter- Irritation: — Such  as  blisters,  may  be  of 
service  in  some  cases,  but  onh'  when  the  disease  is 
local  and  not  when  the  inflammation  is  genernl. 

Leeches :^Are  generally  condemned  (L.  T.),  but  in 
sthenic  t^^pes,  in  plethoric  persons,  when  the  inflam- 
mation is  localized,  they  are  advocated  by  some 
authorities.     (Ty.) 

Intravenous  Saline  Injection: — This  measure  may 
be  employed  in  septic  peritonitis  when  death  seems 
inevitable. 

TUBERCULOUS  PERITONITIS. 

Simple  Incision  with  Free  Evacuation: — Most  suc- 
cessful of  am'  of  the  measures  employed ;  the  best  re- 
sults w-ere  obtained  when  the  abdomen  was  neither 
flushed  out  nor  drained,  but  when  the  effusion  had 
been  simply  evacuated  and  the  wound  closed.  (T., 
97.) 

Dr.  F.  S.  Dennis  gives  the  following  directions  in 


PERNICIOUS  MALARIAL   FEVER.  451 

regard  to  laparotomy  for  this  disease :  Certain  cases, 
especially  of  the  fibrous  form,  ma3^  occasionally  re- 
cover without  surgical  intervention.  The  majority 
require  laparotomy,  since  the  mortality  of  the  opera- 
tion itself  is  practically  nothing,  and  the  operation 
rescues  the  patient  from  a  general  tuberculosis  of 
which  the  peritoneal  invasion  is  only  a  local  mani- 
festation. 

Laparotomy,  to  be  a  life-saving  measure,  should 
be  resorted  to  earh'^  in  the  history  of  the  disease, 
since  late  operations  show  less  favorable  results.  It 
is  not  contra-indicated  when  onlj^  a  slight  invasion 
exists  in  the  lungs  and  pleurae,  since  the  operation 
often  cures  the  pulmonary  infection.  It  is  contra- 
indicated,  however,  when  acute  miliary  tuberculosis 
is  present,  also  when  the  viscera  are  extensively  in- 
volved. It  is  called  for  as  a  further  curative  measure 
if  ascites  develops  after  the  first  operation.  (P.  M. 
J.,  9,  30,  99.) 

Collodion: — Several  cases  have  been  reported  by 
French  ph^^sicians  in  which  repeated  applications  to 
the  abdomen  over  its  entire  surface  have  been  fol- 
lowed by  recovery.     (Sm.) 


PERNICIOUS    MALARIAL  FEVER. 

A  reaction  should  be  brought  about  at  once.  If  in 
the  cold  stage,  apply  Heat  to  the  surface.  When 
there  is  cerebral  congestion,  Cold  to  the  head.  Cold 
is  contra-indicated  if  the  face  is  pale.  Remissions  are 
greatly  promoted  by  the  free  and  frequent  use  of  Hot 
Mustard  Foot  Baths.     (Rd.)  (Ga.) 


452  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Quinine: — Hypodermically,  is  advised  in  all  varie- 
ties of  pernicious  intermittents ;  the  patient  should 
be  cinchonized  and  kept  so  for  several  days.     (An.) 

The  soluble  salts  should  be  used,  such  as  the  tan- 
nate,  hydrobromate  and  hydrochlorate,  in  doses  of 
15  grains  in  distilled  water,  Avith  1  grain  of  sodium 
chloride,  or  the  bisulphate  in  doses  of  30  grains,  with 
5  grains  of  tartaric  acid.  The  muriate  of  quinine 
and  urea,  in  doses  of  from  10  to  20  grains,  may  also 
be  administered.  These  doses  may  be  much  increased 
if  necessary.  The  liability  to  the  formation  of  ab- 
scesses after  the  hypodermic  administration  of  qui- 
nine must  be  taken  into  consideration.     (Ty.) 

Amyl  Nitrite: — Inhalation  may  modify  the  cold 
stage,  but  has  no  influence  on  the  hot. 


PERTUSSIS. 

Of  the  numerous  agents  used  specially  for  their 
germicidal  and  antispasmodic  effects,  the  following 
may  be  commended : 

Carbolic  Acid: — A  solution  of  5-1000,  as  a  spray, 
seems  to  be  valuable,  and  is  much  used.     (Ty.) 

A  form  of  the  crude  acid  is  sold  under  the  name  of 
Cresolene,  the  vapor  of  w^hich  is  allowed  to  impreg- 
nate the  apartment.  The  remedy  is  prepared  for 
vaporization  by  heating,  and  it  is  thought  to  modify 
the  disease. 

Resorcin: — 1  per  cent,  solution,  applied  to  the 
larynx,  is  ver\'  effective.     (T.,  98.) 

Hydrogen  Peroxide: — One  of  the  best  and  least  ir- 
ritating antiseptic  applications  for  this  disease.     It 


PERTUSSIS.  453 

should  be  sprayed  directly  into  larynx  two  or  three 
times  a  day,  in  the  strength  of  1  part  of  the  30  vol- 
ume peroxide  (hydrozone),  with  distilled  w^ater,  10 
parts,  and  glycerine,  ll^  parts.  Hydrogen  peroxide 
is  also  used  diluted  with  2  parts  of  Dobell's  solution. 
It  is  discountenanced  by  some  observers. 

Menthol: — 20  grains  in  liquid  vaseline  in  an  ordi- 
nary nasal  spra^--,  as  soon  as  paroxysm  begins,  or 
seems  impending.  Diffuse  a  fine  cloud  of  spray  in 
front  of  the  face,  the  spray  being  held  about  two  feet 
away.  The  effect  is  beneficial,  the  paroxysm  soon 
over,  and  mucus  rapidly  expectorated. 

Citric  Acid: — Moncorvo  speaks  highly  of  applica- 
tions of  a  10  per  cent,  solution  of  citric  acid  to  the 
pharynx  and  larynx  in  whooping  cough.  These  ap- 
plications are  made  every  two  hours  by  means  of  a 
fine  brush  with  a  curved  handle.  He  claims  that 
under  this  treatment  the  attacks  rapidly  diminish  in 
frequency"  and  intensity,  and  that  a  cure  is  effected  in 
from  15  to  20  days.     (J.  P.,  7,  8,  99.) 

Boric  Acid: — Insufflation  of  3  grains  into  the  nose 
every  three  hours.     (Sn.) 

Nitrate  of  Silver: — Used  as  a  spray  in  1  to  2  per 
cent,  solution.  (Jac.)  It  stains  clothing,  how^ever, 
and  is  not  applicable  to  young  children. 

Chloroform  or  Ether  Inhalations: — Preferably  the 
former,  are  very  beneficial  w^hen  convulsions  have  oc- 
curred, or  are  feared ;  also  the  following  combina- 
tion: 

1^.    Chloroformi,  ^j. 

Ether.  Sulphurici,  ^ij. 

Ess.  Terebinth,  Rect.,  Sijss. 

M. 

Sig.    Pour  a   teaspoonful   upon    handkerchief,    and   hold    to 
child's  nose  during  paroxysm.     (Sn.) 


454         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Hydrarg.  Bichlorid.:— Sprays  of  1-4000  solution. 
(Ty.)  Caution  evidenth'  necessar3'  as  to  frequency 
of  application  and  quantity  applied.  Rabinschek's 
method  (B.  M.  P.,  8,  13,  96)  consisting  of  the  in- 
troduction into  the  back  of  the  mouth  of  a  small 
tampon  saturated  with  a  solution  of  1—1000,  which 
is  pressed  against  the  base  of  the  tongue,  so  as  to 
enable  the  solution  to  bathe  the  epiglottis  and  neigh- 
boring parts,  is  said  to  be  efficacious ;  but,  inasmuch 
as  in  a  small  number  of  cases  temporar\'  disturb- 
ances have  been  observed,  such  as  haemorrhages  of 
the  conjunctiva  and  the  ear,  buccal  ulceration,  and 
slight  fever  (which  were  described  by  the  author  as 
not  at  all  serious),  this  method  of  treatment  would 
scarcely  seem  to  be  advisable. 

Thymol: — Inhalations  are  sometimes  serviceable. 
A  good  formula  is  as  follows  : 

Vi.    Mentholi, 

Thymoli, 

Acid.  Carbolici,  a^  gr.  v. 

Ol.  Eucalypti,  ^ij. 

Ol.  Pini  Sylvestris,  ^"j- 

M. 

Sig.     A  teasjwonful  to  about  a  pint  of  boiling  water  or  a  few 
drops  on  cotton,  inhaled.  (F. ) 

Sodium  Sozoiodate: — The  pov^der  blo\vn  into  the 
nose  in  doses  of  3  grains  dailv  is  said  to  be  effective. 

Ozone: — The  sick  room  ma}'  be  charged  with  the 
gas  in  moderate  quantities  w^ith  benefit,  improving 
the  condition  of  the  patient,  and  minimizing  conta- 
gion.    (F.) 

Poultices : — Large  enough  to  cover  posterior  sur- 
face of  lungs ;  on  this  the  child  is  made  to  lie  for  one 
hour.     Relief  is  almost  immediate.    After  remoAal, 


PERTUSSIS.  455 

rub  in  skin  previoush'  covered  by  poultice,  sweet  oil 
and  camphor  then  appl3^  cotton  jacket.     (Sj.) 

Asparol: — 1  per  cent,  aqueous  solution  applied  on 
gauze  over  periglotteal  region.     (Sj.) 

Carbonic  Acid  Gas: — Inflation  of  rectum  with  this 
gas  has  been  attended  with  success.     (F.) 

Formaldehyde : — A  1  per  cent,  solution  is  used  suc- 
cessfully as  a  spray  three  times  daily  for  fifteen  min- 
utes at  a  time.  (F.)  The  paroxysms  are  diminished, 
both  in  frequenc3^  and  intensity.     (Sj.) 

Cocaine  Hydrochlorate: — A  5  per  cent,  solution  to 
the  pharynx.     (Jac.) 

Amber  Oil: — Useful  as  an  embrocation,  enters  into 
the  combination  of  a  well  known  English  nostrum 
called  "Roche's  Embrocation,"  which  is  composed  of 
olive  oil  mixed  with  half  its  weight  of  oil  of  cloves 
and  oil  of  amber.     (Cool.) 

Sulphur  Fumigations: — Remove  the  child  from  the 
room  in  the  morning,  wash  and  dress  in  clean  fumi- 
gated clothing ;  then  close  the  room  to  be  fumigated 
for  four  or  six  hours,  allowing  sulphur  to  be  freely 
burned  in  it.    (Gn.) 

Eucalyptol: — The  fumes  as  an  inhalation,  or  a 
spray  as  follows :  2  drachms  of  the  oil  with  2  of  tere- 
bene,  and  alcohol  IV2  ounces,  apply  half  an  hour 
before  each  meal,  and  at  bed  time.     (F.) 

Quinine: — Insufflations  have  been  employed,  and 
considerable  doses  have  been  given  to  be  swallov^^ed 
slowly  for  their  topical  effect.  Sprays  were  formerly 
much  employed. 


456  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

PHAGEDENA. 

See  also  Gangrene. 

Nitric  Acid: — The  foremost  topical  remedy,  steep 
the  effected  part  with  the  fuming  acid ;  if  ulceration 
is  extensive,  chloroform  may  be  administered. 

Bromine: — In  using  this  agent  it  should  be  remem- 
bered that  it  is  one  of  the  most  powerful  escharotics, 
and  that  its  action  is  not  altogether  controllable.  It 
causes  widespread  destruction  of  the  tissues  which 
are  slow  to  heal.  Its  use  in  the  pure  state  is  mosth- 
confined  to  hospital  gangrene.  An  aqueous,  y\  per 
cent,  solution,  is  employed  for  washing  phagedaenic 
w^ounds.  All  disorganized  tissues  should  be  first  re- 
moved by  hydrogen  peroxide  irrigations,  the  scissors 
and  forceps.  Then  irrigate  with  the  bromine  solu- 
tion. If  gangrene  is  extensive,  pure  bromine  maj'  be 
used,  the  patient  being  under  an  anaesthetic.  Com- 
presses w^et  with  the  bromine  solution  are  placed 
over  the  w^ound,  covered  with  oiled  silk  and  a  band- 
age. Dressing  should  be  changed  every  twelve  to 
twenty-four  hours  for  the  first  two  to  four  days, 
v^^hen  the  granulating  surface  should  be  clean.  Then 
apply  simple  sterilized  water  dressings,  or  one  con- 
taining 1  per  cent,  of  sodium  chloride,  or  5  per  cent, 
of  boric  acid,     (F.) 

Carbolic  Acid: — The  undiluted  acid  is  superficial  in 
its  eifects,  but  will  be  found  very  useful  in  mild  cases. 
(N.) 

Potassium  Chlorate: — The  powder  thickly  sprinkled 
over  sore,  proves  a  manageable  and  effective  remedv. 
(B.) 


PHAGEDENA.  457 

Hydrated  Silica : — This  substance  is  a  jelly-like 
mass  and  is  prepared  by  Dr.  H.  G.  Piffard  according 
to  a  process  devised  by  Dr.  C.  Rice.  It  is  said  to  be 
most  effective  in  controlling  profuse  suppuration. 

The  silica  is  packed  closeh^  in  the  part,  and  the 
dressing  renewed  once  or  twice  a  day.  If  applied  too 
long  it  will  devitalize  the  tissues  and  cause  extensive 
sloughing.     (F.) 

Pyrogallic  Acid: — A  powder  made  of  1  part  of  the 
acid  with  4  of  starch  has  been  found  effective,    ( F. ) 

Mercuric  Nitrate: — A  useful  caustic;  its  especial 
value  is  its  speedy  destruction  of  rapidly  advancing 
ulceration.     (F.) 

Zinc  Chloride : — This  powerful  caustic  may  be 
dusted,  in  the  form  of  a  powder,  over  the  ulcerating 
surface.  A  superficial  slough  forms,  which  may  be 
removed  by  poultices.     (B.) 

Immersion  in  Hot  Water: — Recommended  by  Mr. 
Hutchinson.  The  part  is  placed  in  a  bath  at  a  tem- 
perature 95°  to  98°  and  allowed  to  remain  for  eight 
hours  at  a  time.  After  two  or  three  baths  a  healthy 
appearance  may  be  looked  for.  This  method  is  said 
to  have  been  very  successful  in  the  treatment  of 
phagedasna  of  venereal  sores. 

Cauterization: — By  the  galvano-cauter^^  or  Paque- 
lin,  preferably  the  former,  will  sometimes  arrest  the 
morbid  process  w^hen  other  measures  have  failed. 

Salicylic  Acid,  Boric  Acid,  Europhen,  Iodoform, 
and  Xeroform,  applied  to  the  sloughing  surfaces  and 
adjacent  healthy  tissues,  are  all  effective  when  dust- 
ing powders  are  indicated. 

For  cleansing  and  deodorizing,  solutions  of  Hy- 
drarg.  Bichlorid.,  1-2000;  Hydrogen  Peroxide,  pure 
or  diluted;  Carbolic  Acid,  in  various  strengths;  Po- 


458    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

tass.  Permang.,  about  5  to  10  grains  to  the  ounce, 
and  Labarraque's  solution. 


PHARYNX,  ADENOID  GROWTHS  OF 
—HYPERTROPHY  OF  THE  PHAR- 
YNGEAL TONSIL. 

Mild  treatment  should  be  tried  first.  The  follow- 
ing are  of  service:  Sodium  Benzoate,  gr.  x-5J ;  Po- 
tassium Chlorate,  gr.  xx— |j ;  Dobell's  Solution,  or 
the  following  formula : 

^.    Fid.  Ext.  Hamamelidis  Destill., 

Aq  Rosae,  aa  ^ij. 

M.  (Bn.) 

Tannin : — One  of  the  best  applications,  a  solution 
of  40  grains  to  the  ounce  of  glycerine,  painted  on 
with  a  suitably  curved  post-nasal  applicator,  after 
the  use  of  sprays  (B.);  or  the  follow^ing  combination : 

^.    Acid.  Tannici,  gr.  xl. 

Acid.  Carbolici,  gr.  j. 

Sodii  Boratis,  gr.  xx. 

Glycerini,  §  ss. 

Aquse,  ad  ^iv. 

M. 
Sig.     This  may  be  applied  twice  daily.  (Bos.) 

Resorcin: — 100  per  cent,  solution  has  been  used 
successfully,  one  observer  declares  that  it  obviates 
the  need  of  surgical  measures.  The  time  required  for 
treatment,  however,  was  from  two  to  four  months. 
(T.,  98.) 

When  milder  measures  fail,  chromic  acid,  the  gal- 
vano-cautery,  the  curette,  or  forceps  should  be  em- 
ployed for  the  removal  of  the  growths.     (Iv.) 


PHARYNX,  ADENOID   GROWTHS   OF.  459 

Chromic  Acid  : — Ma\^  be  applied  on  a  probe  in  the 
form  of  the  fused  crystals  or  in  a  saturated  solution, 
preferably  the  former.  Apfplications  should  be 
guarded,  and  the  rhinoscopic  mirror  used.  Three  or 
four  applications  may  be  made  at  weekly  sittings, 
the  saturated  solution  on  cotton  being  used.  Care 
must  be  exercised  lest  the  acid  flow  down  the  throat 
and  cause  severe  inflammation  and  spasm.     (Iv.) 

Galvano-Cautery :  —  Among  the  most  efficient 
methods  of  treatment.  A  good  practice  is  to  burn 
awaj^  tvv^o  or  three  prominent  nodules  at  each  sit- 
ting, repeating  the  operation  in  a  week  or  two  if  nec- 
essary. This  method,  however,  is  not  suitable  for 
children.     (Bp.) 

Curettage: — For  this  purpose  employ  Meyer's 
method,  an  L  shaped  curette,  a  finger  curette,  or  the 
finger  nail;  general  anaesthesia  and  antisepsis  are 
necessary.  Some  writers  regard  this  measure  as 
peculiarly  dangerous,  and  only  to  be  performed  by 
an  expert.     It  is  not  adapted  for  use  v^dth  children. 

Curved  cutting  and  crushing  Forceps  are  used  to 
tear  away  the  growths.  The  haemorrhage  is  quite 
profuse  for  a  time,  but  soon  subsides. 

Suprarenal  Extract : — The  recent  introduction  of 
this  agent  for  operations  on  the  nose  and  throat  is 
apparently  only  second  in  importance  to  that  of  co- 
caine. It  is  a  powerfiil  vaso-constrictor  and  con- 
tractor of  erectile  tissues.  By  its  use  nose  and  throat 
operations  can  be  greatly  facilitated  and  rendered 
almost  bloodless. 

Its  blanching  properties  are  very  powerful ;  a  drop 
of  a  1  per  cent,  solution  instilled  into  the  eye  v^ill 
produce  an  ivory  whiteness  of  lid  and  conjunctiva  in 
less  than  one  minute.     It  is  painless,  non-antiseptic, 


460  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

and  non-reactionary.  A  tolerance  is  not  established 
by  its  use  and  there  does  not  appear  to  be  any 
danger  to  the  tissues  of  the  individual.  The  remedy 
may  be  mixed  vvnth  cocaine.  The  method  of  its  ap- 
plication is  as  follows :  Place  5  grains  of  the  dessi- 
cated  suprarenals  in  1  drachm  of  a  cold  boric  acid 
solution  and  allow  the  mixture  to  stand  ten  minutes, 
filter  and  appl)\  The  full  effects  will  be  observed  in 
a  few  seconds  and  will  continue  for  one  or  two 
hours. 


PHARYNGITIS. 

ACUTE  CATARRHAL  PHARYNGITIS. 

Many  simple  cases  disappear  without  treatment. 
Tw^enty-four  hours  in  bed  is  about  the  best  medicine. 
Local  applications,  when  required  for  the  comfort  of 
the  patient  should  be  astringent  and  soothing.  They 
may  be  administered  in  the  form  of  sprays,  gargles, 
or  inhalations.  Gargles  are  of  utilitj^  if  used  accord- 
ing to  the  method  of  Hagen,  otherwdse  the  fluid 
rarely  passes  beyond  the  pillars  of  the  fauces.  Hagen 
advised  that  the  mouth  be  a  little  more  than  half 
filled  with  the  gargle,  the  head  bent  back,  the  mouth 
open  and  a  complete  act  of  deglutition  performed 
with  the  mouth  still  open ;  the  air  is  now  allowed  to 
gurgle  through  the  solution  as  long  as  possible,  and 
then  it  is  expelled.     (Iv.) 

The  following  are  for  use  as  gargles  or  sprays  in 
solution  with  1  ounce  of  water : 

Potassium  Chlorate,  gr,  x— v. 

Sodium  Borate,  gr.  x. 


PHARYNGITIS.  461 

Sodium  Bicarbonate,  gr.  viij. 

Alum,  gr.  Y. 

Tannic  Acid,  gr.  v. 

Acetanilid,  gr.  iv. 

Tr.  Capsicum,  gr.  iij-iv. 

Tannate  of  Glycerine,  3j. 

Ext.  Hamamelis,  .^ij-iij. 

Rhus  Glabra : — Said  to  be  one  of  the  best  remedies 
as  a  gargle ;  use  2  drachms  of  the  fld.  extract  to  4 
ounces  of  -water,  to  which  2  scruples  of  chlorate  of 
potash  have  been  added.     (Al.) 

Fluid  Petroleum  Preparations : — Such  as  Ben-' 
zoinal,  Albolene,  etc.,  are  often  very  soothing  v^hen 
applied  in  the  form  of  sprays. 

Tannic  Acid : — 15  grains  to  1  ounce  of  water,  is  of 
service  when  there  is  oedema.     (Iv.) 

Menthol: — An  agreeable  application,  has  positive 
value  in  controlling  inflammation.  Spraj'S  of  from 
2  to  10  per  cent,  are  agreeable  and  effective  pallia- 
tives. 

Lozenges : — Are  often  of  service  in  allaying  the  irri- 
tation of  the  throat;  the  following  are  recom- 
mended, the  latter  being  indicated  when  there  is 
considerable  secretion  which  is  not  easily  expec- 
torated (Bos.): 

9;.    Ext.  Eucalypti,  jss. 

Sodii  Boratis,  gr.  x. 

Pulv.  Pimentse,  gr.  vij. 

Ext.  Glvcvrrhyzse,  ^jiiss. 
M.                  '    ' 

Ft.  mass,  in  trochisca,  No.  xxx. 

1^.    Ammon.  Muriatis,  ^ss. 

Pulv.  Ipecacuanhae,  gr.  ij. 

Pulv.  Capsici,  gr.  ss. 

Ext.  Glycyrrhyzse,  ^iiss. 
M. 

Ft.  iiiassa  in  trochisca,  No.  xxx. 


462  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Gallic  Acid: — Mixed  with  Tannic  in  proportion  of 
1  to  3,  said  to  modify  irritating  effects  of  the  latter; 
about  5  grains  of  the  mixture  to  1  ounce  of  w^ater. 

Thymol:— Solution  of  1-1000  or  2000,  is  especi- 
ally valuable  in  the  exanthematous  varietj^.     (Al.) 

Inhalents  are  sometimes  affective  in  soothing  the 
irritation ;  the  following  are  suggested :  Benzoic 
Acid,  3  grains  with  12  grains  of  kaolin,  rub  well 
together  and  add  tr.  tolu,  18  drops,  and  water,  1 
ounce.  Add  a  teaspoonful  to  a  pint  of  hot  v^ater 
and  inhale  vapor.  (Lefferts.)  Thuja,  a  few  drops  of 
the  essential  oil  in  a  pint  of  w^ater,  temperature  140°. 
Chamomile  infusion  is  useful  for  children.    (Al.) 

Cold: — Ice  water  compresses  to  the  throat  or  small 
ice  bags  with  dry  to\vels  covering;  also  sucking 
small  pieces  of  ice. 

Counter- Irritation  : — Mustard  leaves  sometimes 
better  than  cold,  as  all  throats  do  not  bear  cold 
equally  well.     (Ty.) 

Scarification  of  Uvula: — When  the  uvula  is  very 
oedematous  and  elongated,  it  is  the  source  of  con- 
stant irritation  and  discomfort,  in  this  condition 
scarification  or  puncture  v^ill  afford  prompt  relief. 
(PP-) 

CHRONIC  CATARRHAL  PHARYNGITIS. 

This  condition  is  usually  secondary  to  some  other 
affection,  such  as  naso-pharyngeal  catarrh,  obstruct- 
ive lesions  of  the  nose,  excessive  use  of  tobacco,  or 
chronic  gastric  catarrh.  Treatment,  therefore,  should 
be  directed  tow^ard  eliminating  these  causes ;  at  the 
same  time,  local  applications  should  be  made  to  the 
pharynx  every  two  or  three  days. 


CHRONIC    FOLLICULAR    PHARYNGITIS.  463 

The  throat  should  first  be  cleansed  with  some  anti- 
septic or  alkaline  spraj^  such  as  Dobell's  or  Seller's 
Solution.  This  constitutes  a  ver3^  important  meas- 
ure. After  cleansing,  the  selected  remedy  may  be  ap- 
plied ;  the  following  solutions  will  be  found  of  ser- 
vice: 

Potass.  Bichromate,  1  per  cent.;  Potass.  Permang., 
1  percent.;  Sodium  Bicarbonate,  5  per  cent.;  Euca- 
lyptus, 10  per  cent. 

When  the  above  have  failed,  one  of  the  follo^ving, 
combined  with  1  ounce  of  Glycerine,  is  used;  Tannic 
Acid,  10  grains;  Zinc  Chloride,  5  grains;  Iodine, 
10  grains.     (Iv.) 

The  following  are  also  recommended  :  Argent.  Nit., 
10  to  20  grains  to  the  ounce;  Zinc  Sulphate,  10  to 
20  grains  to  the  ounce;  Liq,  Ferri.  Persulphatis,  10 
drops  to  the  ounce. 

Pyoktanin  Blue: — 71/2  grs.  with  2  drachms  of  wa- 
ter; 10  minims  of  this  solution  with  1  ounce  of  gly- 
cerine ;  apply  with  brush,  especially  when  hypersecre- 
tion is  a  prominent  symptom.    (Iv.) 

Glycerine: — Painting  the  throat  is  of  value,  as  this 
agent  depletes  the  mucous  membrane.     (Gn.) 

Cold  Salt  Water: — As  a  preventive ;  bathe  the  neck 
and  upper  part  of  chest  with  cold  salt  water,  and 
afterward  rub  wnth  rough  towel. 

CHRONIC  FOLLICULAR  PHARYNGITIS. 

Galvano-Cautery: — While  there  is  some  divergence 
of  opinion  in  regard  to  the  expediency  of  destroying 
the  enlarged  follicles  by  cauterization  before  employ- 
ing milder  measures,  it  seems  to  be  a  very  generally 
approved  method  for  the  cure  of  this  affection.     The 


464  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

best  agent  to  employ  is  the  electro-cauter3\  Each  fol- 
licle is  touched  wath  the  needle  once,  and  in  the. case 
of  very  large  follicles,  the  application  should  be  made 
several  times.  The  needle  should  be  fine  and  brought 
to  a  red  heat.  It  is  advisable  to  go  over  the  phar3^nx 
at  intervals  of  a  vv^eek  until  inspection  shows  all  en- 
larged glands  to  have  been  eradicated. 

While  many  writers  consider  the  above  the  only 
satisfactory  treatment,  other  and  milder  measures 
are  recommended.  Some  of  these  are  employed  as 
follows : 

Nitrate  of  Silver: — Solutions  of  40  to  60  grains  to 
the  ounce,  have  been  employed  after  the  removal  of 
the  mucus.  The  hypertrophied  tissues  are  to  be 
touched  individually.  Another  method  of  applica- 
tion consists  in  splitting  the  follicle  with  a  knife,  and 
crowding  in  the  silver.  ( Ing. )  The  knife  and  caustic 
may  be  advantageously^  employed  when  the  cautery 
is  not  available.     (L.  B.) 

Hydrastine: — By  insufflation,  is  indicated  in  cases 
w^here  the  follicles  are  of  a  deep  red  color,  where  the 
surrounding  mucous  membrane  is  moist  and  the 
secretion,  except  in  the  naso-pharynx,  is  not  excess- 
ive ;  use  25  grains  with  75  of  acacia.  At  first  employ 
small  quantities  only  in  order  to  ascertain  suscepti- 
bility of  patient,  as  remedies  applied  in  this  way 
sometimes  cause  pain.     (Ing.) 

Astringent  sprays  of  Alumnol,  15  to  20  grains; 
Cuprum  Sulphate,  10  to  20  grains;  Zinc  Chloride, 
15  to  20  grains;  Zinc  Sulphate,  10  to  20  grains,  of 
either,  to  water  1  ounce,  will  occasionally  prove  use- 
M.     (Ing.)     (V.  H.) 

Pyoktanin  Blue: — Saturated  solutions  applied  to 
each  follicle  are  recommended.     (Gn.) 


PHLEBITIS.  465 

Iodine  : — A  solution  in  glycerine.     (Gn.) 

Curettage : — Recommended  by  Lennox  Browne  in 
obstinate  cases. 

Mineral  Cauterants: — The  following  may  be  em- 
plo^'ed  when  the  follicles  are  much  enlarged :  Nitric 
Acid,  Chromic  Acid,  and  London  Paste  applied 
carefully  to  each  follicle  individually.  These  caustic 
applications  ma\^  be  repeated  in  four  or  five  days. 
(Ing.)  Zinc  Chloride,  20  to  40  grains  to  the  ounce, 
is  also  applied  to  the  indurated  tissues.  These  meas- 
ures, for  the  most  part,  are  now  obsolete. 

Krameria: — Will  form  a  mild  trochee;  useful  as  a 
palliative  astringent,  about  3  grains  to  a  trochee,  or 
the  follow^ing  in  each : 

I*.    Ext.  Kramerise,  gr.  j. 

Pulv.  Cubebse,  g^-  i- 

Potass.  Chloridi,  gr.  ij. 

M.  (lug.) 


PHLEBITIS. 

Rest  in  bed  constitutes  the  first  essential  of  treat- 
ment. The  affected  part  should  be  elevated  if  possi- 
ble and  enveloped  in  cotton. 

Ice  : — Should  be  applied  to  the  parts  when  the  tem- 
perature is  high.     (Gn.) 

Hamamelis:  —  Applied  on  compresses  acts  well. 
(Rd.) 

The  following  anodyne  preparations  are  recom- 
mended : 

^;.    Ext.  Belladonnse, 

Ext.  Hyoscyami,  aa  gr.  xxx. 

Adipis  Benzoatis,  .^j. 

M. 

31 


466  DIGEST   OF  EXTERNAL  THERAPEUTICS. 

Or, 

9;.    Chloroformi, 

lyin.  Camphorse,  aa  ^ij. 

Glycerini,  ^iv. 

M. 

Or, 

9;.    Ichthyoli,  gr.  xv. 

Lanolini,  ^j. 

M.  (T.  G.,  9,  15,  96.) 

Goulard's  Lotion  with  Opium: — A  useful  anodyne 
lotion.     (HI.) 

Free  Incision: — Is  indicated,  if  suppuration  ensues; 
the  incisions  are  made  parallel  to  the  veins,  and  free 
drainage  established.  A  wet  dressing  should  be  ap- 
plied, and  the  wounds  freely  irrigated  with  sublimate 
solution  1-1000.     (W.) 


PHLEGMASIA  ALBA  DOLENS. 

See  Phlebitis. 

PITYRIASIS  CAPITIS. 

Treatment  of  this  affection  is  chiefly  local.  Before 
the  application  of  any  remedy  first  clean  the  scalp 
with  soap  and  water,  or  if  the  crusts  are  very  thick 
soften  them  with  Olive  Oil  and  then  shampoo  the 
head  withSpts.Saponis  Kalini.  According  to  Hebra, 
this  remedy  is  made  by  dissolving  2  drachms  of  the 
green  soap  in  1  once  of  alcohol;  perfume  if  desired 


PITYRIASIS  CAPITIS.  467 

with  oil  of  lavender,  or  bergamot.  Applj^  the  soap 
with  water,  a  teaspoonful  with  a  teaspoonful  of 
water,  well  worked  up  into  a  lather,  and  quickly 
clean  the  scalp.  Afterw^ards  cleanse  with  cold  water 
and  apply  the  selected  remedy.  In  ordinary  cases 
where  the  scales  are  loose  and  dry,  remedies  may  at 
once  be  applied,  such  as  the  preparations  of  resorcin, 
sulphur,  and  salicylic  acid. 

Lotions  are  generally  best  when  the  hair  is  thick ; 
ointments  are  useful  when  it  is  thin.  The  following 
are  well  attested  formulae : 

Resorcin: — Gives  excellent  results,  useful  in  obsti- 
nate case,  and  in  those  in  which  there  is  considerable 
effluvium  capillorum,  viz.:  • 


^.    Resorcini, 

9iv-ij. 

Ol.  Ricini  Pur., 

3iv. 

Alcohol.  Fort., 

3v. 

Balsam.  Peru., 

gtt.  xij. 

M. 

Sig.     Rub  in  scalp  once  or  twice  daily. 

/I , 
{t.    Resorcini, 

gr.  x-xx, 

Sulphur.  Praecipitati, 

5j. 

Ung.  Aquae  Rosse  vel  Ung.  Simp., 

Sij- 

M.    . 

Sig.     Rub  in  scalp  once  or  twice  daily. 

If  resorcin  is  used  alone  it  should  be  dissolved  in  a 
bland  oil.     (B.  H.) 

Salicylic  Acid: — Dissolved  in  water,  forms  a  useful 
lotion  for  cases  in  which  desquamation  is  a  most 
marked  feature.     (F.) 

Thymol : — In  the  following  lotion,  can  be  used 
freelv : 


468  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

9r.    Thymoli,  3j. 

Liq*  Potassae,  f  3j. 

Aq.  Laurocerasi,  Oj. 

M. 
Sig.     Apply  daily.     (Vn.) 

An  ointment  of  10  per  cent,  and  upward  is  also 
used.  When  one  stronger  than  20  per  cent,  is  de- 
sired, the  thvmol  should  first  be  dissolved  in  alcohol. 

(F.) 

Carbolic  Acid: — The  following  combination  is  to  be 
preferred  when  the  hair  is  thick,  to  be  applied  after 
washing  wnth  green  soap : 

^.    Acid.  Carbolici,  9j. 

Alcohol,  vel  Aq.  Coloniensis,  3J^- 

,  Glycerini,  oU^s. 

01.  Limonis,  oj^s. 
M. 

A  few  drops  of  this  mixture  are  applied  here  and  there  over  the 
surface  by  means  of  an  eye  dropper,  and  rubbed  in  well  with  a 
stiff  brush.  The  mixture  may  be  scented  if  desired.  Apply  daily. 
(Vn.) 

Oleum  Rusci  Crudum: — Excellent  as  a  lotion  or 
pomade.    The  lotion  is  as  follows : 

9r.    Ol.  Rusci  Crudi,  gtt.  xv-3iiss. 

01.  Ricini  Puri,  3J-ij- 

Ol.  Bergamot., 

Ol.  Citronelli,  aa  gtt.  xv. 

^ther.  Sulphuric,  9ij. 

Alcohol.  Fort.,  q.  s.  ad  §vij. 

M. 
Sig.     Apply  daily  with  brush. 

The  pomade : 

9;.    Ol.  Rusci  Crudi,  3  ivss. 

Vaselini  Albi,  ^vss. 

Paraffini,  ,^j. 

Ol.  Bergamot.,  3iss. 

Ol.  Citronelli,  jij. 
M. 
Sig.     Rub  in  scalp  with  finger. 


PITYRIASIS  CAPITIS.  469 

These  preparations  will  remove  the  scales  and  im- 
prove the  functions  of  the  glands  to  the  extent,  it  is 
said,  of  restoring  the  hair.     (B.  H.) 

Resorcin  and  Salicylic  Acid: — May  be  combined 
advantageous^  in  the  proportions  of  24  grains  of 
each,  with  saponated  gh'^cerine  1  ounce.  The  base 
should  be  melted,  the  salicylic  acid  first  incorporated, 
then  the  resorcin  at  a  lower  temperature;  this  is 
said  to  form  an  excellent  application,  acting  both  as 
a  soap  and  as  an  ointment.     (Al.) 

Sulphur: — Unna  recommends  as  the  best  line  of 
treatment  the  application  of  an  ointment  made  up 
of  1  to  3  parts  of  sulphur  to  30  of  simple  ointment. 
The  head  should  be  first  washed  with  Green  Soap, 
and  the  ointment  then  applied  by  an  attendant 
twice  a  week.  When  there  is  much  falling  of  the  hair 
from  2  to  10  per  cent,  of  Tincture  Cantharides  may 
be  added. 

Pyrogallic  Acid: — 1  drachm  to  the  ounce,  has  been 
used  with  great  benefit,  applied  at  night  and  washed 
off  in  the  morning  with  a  little  soap  spirit.  In  most 
cases  a  little  discoloration  follow^s. 

In  more  chronic  cases : 

Jfc.    zinc.  Carbonatis  Puri,  ;5iv. 

Glycerini, 

Ol.  Cadini,  aa  ^j. 

Cerati  Galeni,  ad  ^viij. 

M. 

Sig.     Rub  firmly  into  surface  night  and  morning;   more  fre- 
quently if  itching  is  present.  (And.) 

The  following  is  recommended  by  Vigier : 
9^.    Hydrarg.  Sulphat.  Flavi,  gr.  xlv. 

Vaselini,  3  xv. 

Ess.  Linionis,  gtt.  xx. 

M. 

Sig.     Keep  in  porcelain  jar.     Apply  at  night  and  wash  off  in 
the  morning. 


470  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Creosote: — Recommended  by  Tilbury  Fox  in  the 
following  formula : 

^.    Creosoti,  M.xxx. 

Gl}'cerini,  giij. 

Aquse,  §v-viij. 
M. 

Borax: — 2  drachms  to  the  ounce  of  glycerine  is  fre- 
quently serviceable.     (Kp.) 


PITYRIASIS  VERSICOLOR. 

Tilbury  Fox  recommends  the  following  measures 
as  being  effective:  A  hot  bath  should  be  taken  for 
three  nights  in  succession,  the  skin  being  vigorously 
scrubbed,  either  with  cheap  yellow  soap,  or  prefer- 
ably Sapo  Viridis,  friction  being  maintained  with  a 
flesh  brush.  The  affected  area  is  then  moistened  with 
Vinegar  and  water,  or  Dilute  Acetic  Acid,  after 
which  it  is  to  be  well  sponged  with  a  solution  of 
Sodium  Hyposulphite  3J— Ij.  The  eruption  usually 
fades  after  the  third  bathing;  should  there  be  a  re- 
crudescence, it  must  be  attacked  with  solution  of 
Corrosive  Sublimate,  gr.  j— ij— §j.     (Hy.) 

Vlemingckx's  Solution: — Diluted  from  three  to  six 
times,  forms  an  excellent  application. 

Tr.  Iodine: — Painted  on  the  part  often  acts  well. 

(F.) 

Sulphur  Baths: — Combined  with  Mercurial  Lo- 
tions, are  used  by  McCall  Anderson. 

Black  Soap : — Is  useful  for  hospital  practice,  in 
scrubbing  the  skin,  a  substitute  for  which  in  private 
practice  is  the  following : 


PITYRIASIS  CAPITIS.  471 

^.    Hydrarg.  Bichlorid.,  9j. 

Sapo.  Viridis,  5"j- 

Spts.  Rectificati,  ^ij. 

01.  Lavandulae,  9j. 

M.  (And.) 

Scrub  the  skin  night  and  morning ;  caution  regard- 
ing absorption  of  mercury.  (And.)  Leloir  modifies 
the  above  formula  by  adding  one  more  ounce  of 
green  soap,  and  twice  the  quantity  of  rectified  spir- 
its.    (T.  C,  Vol.  V.) 

The  following  is  recommended  by  Brocq : 

Salicylic  Acid,  2  to    3  parts. 

Precipitated  Sulphur,  10  to  15  parts. 

Lanoline,  70  parts. 

Vaseline,  18  parts. 

The  following  combination,  according  to  Besnier, 
acts  well : 


Resorcini, 

Acid.  Salicylici, 

aa  gr.  v-xlv. 

Sulphur.  Praecipitati, 

5ss. 

Lanolini, 

Vaselini, 

Adipis, 

aa  3j. 

M. 

Sulphurous  Acid  (pure  or  dilute) ;  Carbolic  Acid 
(V^  to  2  per  cent,  solutions) ;  Hydroxylamine  Hydro- 
chloride (1  grain  with  an  ounce  each  of  alcohol  and 
glycerine);  Hydrargyrum  Sozoiodate  (a  10  per  cent, 
solution  in  water);  Quinine  (5  per  cent,  ointment); 
Wilkinson's  Ointment,  and  the  other  parasiticides 
which  are  employed  in  the  treatment  of  ringworm  of 
the  body,  are  all  well  attested  remedies. 

The  underclothing  should  be  cleansed  frequently, 
and  not  worn  after  treatment  until  it  has  been  thor- 
oughly boiled  in  hot  water. 


472  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


PLAGUE,   THE  BUBONIC. 

The  following  measures  are  recommended  by  A. 
Mitra,  L.  R.  C.  P.,  L.  R.  C.  S.,  Kashmir.     (T.,  98.) 

For  the  hyperpyrexia : 

Cold  Sponging: — When  fever  continues  high  this 
will  be  found  of  benefit.  Cold  baths  are  contra- 
indicated  on  account  of  the  movements  of  the  body 
which  they  necessitate  and  the  great  cardiac  de- 
pression which  accompanies  this  disease. 

Tepid  Sponging: — May  be  found  preferable  to  cold 
in  some  cases. 

Creosote  Inunctions: — 15  drops  ma3^  be  rubbed  in 
near  the  axilla;. 

Antiseptic  Sponging: — During  the  height  of  th6 
fever,  the  entire  surface  of  the  bodj^  should  be 
sponged  lightly  two  or  three  times  a  day  with  the 
following : 

9;.    Thymoli,  gr.  xl. 

Spts.  Rectificati, 

Acid.  Acetic.  Dil.,  aa  ,^iij. 

Aq.  Rosse,  o'^vj. 

M. 

For  the  cerebral  symptoms : 

Cold  to  the  Head: — This  may  be  employed  in  the 
form  of  an  Ice  Cap  and  may  be  applied  continuously ; 
Leiter's  Coil  will  also  prove  effective.  Bathing  the 
temples  with  cold  w^ater  will  be  found  of  service. 

Sinapisms: — Mustard  plasters  to  the  upper  part  of 
the  neck  and  over  the  occiput  are  employed  for  the 
relief  of  headache. 

Morphia  and  Hyoscine: — These  remedies  are  recom- 


PLAGUE,  THE   BUBONIC.  473 

mended  for  the  insomnia  and  may  be  given  hypo- 
dermically.  Morphia  in  doses  of  Vs  to  i^  grain  and 
hyoscine  in  doses  of  ^^^  to  y-  grain. 

For  the  enlarged  glands : 

Hot  Fomentations: — These  may  be  emploj^ed  in 
the  form  of  Hot  Water,  or  spongio-piline  wrung 
out  in  hot  Antiseptic  Solutions,  such  as  Corrosive 
Sublimate.  When  the  glands  are  painful  Laudanum 
or  Belladonna  maj^  be  added. 

When  suppuration  occurs  the  gland  should  be  in- 
cised and  treated  antisepticalh^ 

For  the  relief  of  the  failing  heart : 

Sinapisms: — Should  be  applied  over  the  praecordial 
region  and  to  the  limbs. 

Caffein: — 5  grains  dissolved  by  the  aid  of  5  grains 
of  sodium  benzoate  in  20  minims  of  ^vater  may  be  in- 
jected three  or  four  times  a  day  as  indicated. 

Ether,  the  Ethereal  Solution  of  Camphor,  or 
Strychnia  may  be  administered  hypodermically. 
The  latter  is  recommended  in  doses  of  ^\  grain  at 
first  every  four  hours  until  j\  grain  has  been  given. 

For  coma: 

Cold  Effusions: — If  there  is  fever  this  measure  will 
be  indicated. 

Coffee: — An  enema  of  a  strong  infusion  of  coffee 
should  be  injected. 

For  diarrhoea : 

Enema  of  Opium: — This  may  be  prepared  as  fol- 
lows: Dover's  powder  2  grains,  tannin  10  grains. 
Mix  wath  1  ounce  of  gum  mucilage  and  from  2  to  5 
ounces  warm  w^ater,  arrow^  root  or  starch  and  inject. 

The  following  other  remedial  measures  are  of  im- 
portance:    Injections  of    Saline   Solutions;   Trans- 


474  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

fusion  of  Blood;  Oxygen  Inhalations;  Ergot  or 
Ergotine,  hypodermicall}',  for  haemorrhage. 

Inoculation:  —  Haffkine  has  inoculated  against 
plague  on  the  same  principle  as  against  cholera.  An 
attenuated  viras  of  the  plague  is  injected,  a  mild 
attack  is  produced  which  proves  harmless,  and 
which  is  regarded  as  preventive  against  the  more 
violent  forms  of  infection.  It  is  claimed  that  mor- 
tality has  been  greatl^^  reduced  by  this  measure.  In 
small  communities,  as  among  physicians  and  attend- 
ants, it  has  proved  of  great  value.  Koch  observed 
that  while  inoculation  did  not  afford  complete  im- 
munity in  those  who  had  been  subjected  to  the  pro- 
cedure, if  the  disease  was  contracted,  it  was  of  a  very 
mild  type.  The  partial  immunitj^  is  said  to  last  for 
six  months.  The  method  has  received  the  approval 
of  the  medical  officers  of  the  Indian  government.  (P. 
M.,  3,  99.) 

Yersen's  Serum: — This  has  been  .used  both  during 
the  course  of  the  disease  and  as  a  preventive,  but  the 
subject  is  still  in  a  too  undeveloped  state  to  warrant 
definite  conclusions.  The  experiments  w^hich  were 
first  made  at  Canton  were  successful,  but  those 
made  at  Bombay  later  failed.  A  stronger  serum  has 
been  prepared  which  promises  better  results.  (P.  M., 
3,  99.) 


PLEURISY,  ACUTE. 

Poultices : — Large,  hot  and  frequenth'  applied  are 
generally  grateful  to  the  patient.  (Gn.)  Laudanum 
may  be  poured  on  the  poultices. 


PLEURISY,  ACUTE.  475 

Morphine  : — May  be  administered  hypodermically. 
^'hen  pain  is  severe  and  not  otherwise  relieved. 

Adhesive  Plaster  Straps: — Arranged  so  as  to  re- 
strain the  respiratory  movements,  as  in  fracture  of 
the  ribs,  ^vill,  if  properly  applied,  afford  much  relief. 
The  plasters  should  be  about  2^4  inches  wnde  and  the 
application  should  be  made  after  expiration.     (Gn.) 

Ice  Bags: — Advised  by  some,  but  the  majority  of 
patients  find  hot  applications  more  grateful.     (F.) 

Blisters: — May  be  employed  in  the  earliest  stage 
to  limit  inflammation,  and  later,  in  the  stage  of  effu- 
sion, to  promote  absorption.  In  the  latter  instance 
they  should  be  applied  some  little  distance  from  the 
seat  of  dulness.     (F.) 

Sinapisms  : — Are  often  helpful ;  the  following  is  rec- 
ommended : 

9;.     Pulv.  Sinapis,  §ss. 

Pulv.  Lini,  ,  ^viij. 

Aq.  Bullientis,  q.  s. 

M.  (Sn.) 

Guaiacol: — Useful  in  the  stage  of  effusion  to  pro- 
mote absorption. 

^.    Guaiacoli,  gr.  xlv. 

Tr.  lodi, 

Glycerini,  aa  3  v. 

M. 

Sig.     Paint  over  the  posterior   portion  of   thorax.     Reaction 
appears  in  about  four  hours.  (Sj. ) 

Olive  Oil: — A  recent  method  for  dry  pleurisy  and 
pericarditis  consists  of  the  injection  of  sterilized  olive 
oil,  15  to  45  minims,  over  the  point  of  friction  mur- 
mur.    It  is  not  painful.     (Sj.) 

In  the  latter  stages,  little  is  gained  by  external  ap- 
plications, except  for  relief  of  pain. 


476  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Aspiration : — When  effusions  are  large  this  meas- 
ure should  be  employed.  The  indications  are  as  fol- 
lows : 

"1.  Distension  and  pressure  dangerous  to  life. 

2.  Subsidence  of  fever  and  other  active  symptoms, 
but  no  decrease  in  the  effusion. 

Paracentesis  is  sometimes  rapidly  curative,  as  well 
as  palliative;  therefore  tap  in  delayed  absorption, 
even  if  no  urgent  symptoms  are  present."     (Gn.) 


PLEURODYNIA. 

See  Muscular  Rheumatism. 

PNEUMONIA,  ACUTE  CROUPOUS. 

There  is  considerable  diversity  of  opinion  in  regard 
to  the  utility  of  external  therapeutic  measures  in  this 
disease.  "Pneumonia  jackets,"  heat  and  cold,  in  vari- 
ous forms,  are  all  advocated.  Goodno,  who  recom- 
mends protecting  the  chest  with  a  simple  layer  of 
flannel,  says:  "That  as  good  results  are  claimed  for 
all,  it  may  be  concluded  that  none  are  especially  val- 
uable." The  truth  or  error  of  such  a  conclusion  is 
still  to  a  certain  extent  an  open  question. 

Dry  Cupping : — Applied  to  the  chest  is  often  of  ser- 
vice in  the  early  stages.  After  the  application  of  half 
a  dozen  cups,  a  patient  previously  unable  to  lie 
down,  ow^ing  to  the  dyspnoea,  will  assume  the  re- 
cumbent position  and  fall  asleep. 

Sinapisms : — Are  useful  for  the  pleuritic  pains. 


PNEUMONIA,  ACUTE  CROUPOUS.        477 

"Pneumonia  Jackets:" — These  are  much  in  use, 
especially  in  England  and  in  this  country.  They  may 
either  consist  of  looseh^  quilted  cotton  jackets  or, 
what  is  preferable,  a  piece  of  oiled  silk  cut  out  so  as 
to  fit  the  chest.  On  this  a  layer  of  cotton  iDatting  is 
placed;  the  jacket  is  then  applied,  the  cotton  bat- 
ting next  to  the  skin.  The  jacket,  or  more  correctly 
the  layer  of  cotton  and  oiled  silk,  is  pinned  over  the 
shoulders  and  down  the  front  of  the  chest  with  safety 
pins.  Before  apphang,  the  cotton  batting  may  be 
covered  thickly  with  a  mixture  of  Turpentine  and 
Vaseline,  which,  acting  as  a  mild  counter-irritant,  is 
generally  grateful  to  the  patient. 

Poultices: — Hot  flaxseed  meal  poultices  enveloping 
the  whole  chest  have,  with  good  reason,  gone  out  of 
use.  Whatever  good  results  they  may  have  had,  they 
were  more  than  compensated  for  by  the  evils  of  in- 
convenience of  application,  requiring,  as  they  do,  fre- 
quent changing,  discomfort,  disturbance  and  exposure 
of  the  patient.  Small  poultices  are,  however,  of  benefit 
when  applied  over  circumscribed  areas  as  for  the  relief 
of  pleuritic  pains.  When  the  jacket  is  used,  a  small 
poultice  over  the  surface  of  which  laudanum  has  been 
poured  for  its  anodj^ne  effects,  may  be  slipped  under- 
neath the  edge  and  placed  over  the  painful  part, 
which  is  usually  on  the  side  and  convenient  of  access.' 

It  should  not  be  lost  sight  of  that  if  heat  is  too 
great  between  the  shoulders  it  intensifies  the  con- 
striction of  the  arterioles.  See  Chapman's  Spinal 
Ice  Bag  treatment  under  ParaWsis. 

Cold  Applications: — These  have  latelj'  been  gaining 
favor.  The  method  of  Baruch  is  as  follows :  En- 
velop the  chest  in  a  suitably  fitted  linen  or  cotton 
jacket  wet  with  cold  water.    The  jacket  should  be  re 


478  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

moved  and  a  fresh  dry  one  substituted  whenever  the 
temperature  falls  to  100°,  and  removed  if  it  rises; 
in  this  way,  it  is  claimed,  all  danger  is  averted.  Dr. 
Mays,  of  Philadelphia,  prefers  to  surround  the  af- 
fected area  with  ice  bags  wrapped  in  towels,  but 
they  are  difficult  to  keep  in  position. 

Ice  over  the  praecordial  region  is  recommended  as  a 
refrigerant  and  cardiac  stimulant  in  children.     (Jac.) 

Excellent  results  from  the  use  of  Cold  Compresses 
are  reported  by  Dr.  W.  F.  Jackson,  of  Brockville,  Ont. 
He  claims  lowering  of  temperature,  quieting  of  the 
circulation,  relief  of  pain,  and  promotion  of  general 
bodily  comfort.  Dr.  T.  J.  Mays  reports  a  death  rate 
of  2.7  per  cent,  out  of  74  cases  in  which  cold  water 
treatment  had  been  tried.     (T.,  96.) 

The  cold  compresses  used  for  adults  cover  the  back 
and  front  of  the  chest ;  thej^  are  wrung  out  in  water 
at  a  temperature  of  60°,  and  applied  ever3'  half  hour, 
according  to  indications.  A  higher  temperature  may 
be  used  if  there  is  much  jactitation  and  excitabilit)% 
Cold  A\^ater  may  be  first  dashed  in  the  face  if  there  is 
much  delirium.  Not  a  little  of  the  benefit  of  cold 
compresses  is  due  to  their  tonic  effect  upon  the 
nerve  centres,  and  to  the  relief  of  cerebral  conges- 
tion which  they  induce  by  dilating  the  surface  capil- 
laries.    (T.,  98.) 

Ice  Cradling: — The  following  method  is  described 
by  Dr.  P.  B.  Smith  (Brit.  Med.  Joum.,  May  11,  '95): 
The  patients  were  placed  in  bed  and  over  the  body 
and  legs  two  large  cradles  were  arranged  extending 
from  the  shoulders  to  the  feet.  Six  or  eight  small 
pails  filled  with  ice  were  attached  to  the  arches  of 
the  cradles.  A  thermometer  was  also  attached  to  the 
upper  part  of  the  cradle,  which  was  then  covered 


PNEUMONIA,  ACUTE  CROUPOUS.        479 

^?vith  a  blanket,  then  with  a  Abater  proof,  and  lastly 
with  the  ordinary  covering.  The  pails  were  kept 
filled  with  ice.  The  temperature  under  the  cradles, 
of  the  ward  and  of  the  patient  was  taken  every  four 
hours.  The  temperature  of  the  air  under  the  blankets 
was  also  taken  before  the  cradles  were  arranged. 
This  treatment  was  maintained  until  the  patient's 
temperature  became  normal.  Dr.  Smith's  report  says 
that  the  cases  upon  which  this  method  was  em- 
ployed w^ere  those  of  acute  sthenic  pneumonia.  Out 
of  108  cases  treated  by  sponging  and  ice  cradling, 
10  per  cent.  died.  The  patients,  as  a  rule,  were  said 
to  feel  comfortable,  but  one  or  tw^o  complained  of 
cold  feet.  Dr.  Smith  concludes  from  the  results  of 
his  investigations  that  ice  cradling  is  suitable  as  a 
mild  antipyretic  treatment  in  sthenic  cases.  It  is 
easily  applied  and  not  violent  in  its  effects. 

Dry  Heat: — Dr.  C.  W.  Ingraham  has  adoped  a 
method  of  applying  heat  by  an  apparatus  for  the  cir- 
culation of  hot  water  through  coils  of  rubber  tubing, 
so  arranged  as  to  cover  the  whole  chest.  (N.  Y. 
Med.  Jour.,  May  18,  1895.)  Excellent  results  are 
claimed  for  this  method,  although  its  application 
appears  to  have  been  limited. 

Cold  Baths: — In  the  case  of  children,  the  tub  can  be 
employed,  but  for  adults  compresses  are  preferable. 
When  tubbing  is  administered  begin  with  a  tempera- 
ture of  95°,  and  gradually  lower  according  to  indica- 
tions; continue  for  about  ten  minutes,  and  repeat 
every  three  or  four  hours.     (S.  B.) 

Cold  Packs  : — Generally  preferred  in  infantile  pneu- 
monia, with  hyperp3^rexia.  Wrap  the  child  in  a  wet 
towel,  and  cover  with  a  blanket.  In  urgent  cases 
this  may  be  replaced  by  another  every  two  or  five 


480  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

minutes.  When  frequent  changes  are  undesirable  the 
wet  towel  may  remain  and  the  surface  rubbed  with 
ice.  If  the  temperature  is  reduced  rapidlj'  heat  must 
be  applied.  Feeble  and  ansemic  babies  do  not  bear 
cold  well.  When  the  heart  is  weak  and  extremities 
chilly,  cold  bathing  is  contra-indicated.     (Jac.) 

Hot  Baths: — Also  used  in  infantile  pneumonia. 
They  are  indicated  in  cases  with  high  fever;  when 
the  patient  is  feeble  or  anaemic,  and  when  the  circula- 
tion is  poor,  with  cold  surface  and  high  rectal  tem- 
perature, a  hot  bath  under  these  conditions  will  act 
beneficially.     (Hit.) 

Tepid  or  Warm  Packs: — With  alcohol,  or  a  tepid 
bath,  gradually  cooled,  with  friction  constantly  ap- 
plied, may  be  employed  in  anaemic  children.     (Jac.) 

The  general  indications  for  the  use  of  cold  and  heat 
in  croupous  pneumonia  may  be  briefly  summarized 
as  follows :  In  robust  persons  with  full  strong  pulse, 
with  continued  h3^perpyrexia,  cold  may  be  emplo3^ed ; 
in  patients  of  a  less  vigorous  constitution  and  in 
those  who  are  feeble  and  anaemic  employ  heat,  espe- 
cially when  the  surface  is  cold  and  heart  weak,  con- 
ditions which  decidedly  contra-indicate  cold.  Thus 
the  employment  of  these  powerful  agents  call  for  a 
careful  study  of  each  case.  The  ' '  pneumonia  j  acket ' ' 
w^ith  small  anodyne  poultices  for  the  relief  of  pleu- 
ritic pain  is  the  method  most  frequently  adopted  and 
is  the  practice  of  the  author.  The  various  methods 
of  the  application  of  cold  are  presented  as  the  obser- 
vations of  other  writers. 

Methyl  Chloride : — Has  been  used  to  relieve  local- 
ized pain;  applied  along  the  course  of  the  nearest 
nerve,  is  said  to  afford  instant  relief,     (Sj.) 


POWDER   STAINS.  481 

Blisters  : — Sometimes  claimed  of  service,  especially 
in  delayed  resolution.     (T^^) 

Oxygen  Inhalations: — Are  of  undoubted  value  in 
relieving  the  d3^spnoea.     (Ty.) 

Artificial  Serum: — Injections  have  been  used  after 
the  method  of  Galvagni,  a  solution  of  chloride  and 
bicarbonate  of  sodium  being  employed.  The  report 
is  generally  favorable,  though  the  treatment  is 
too  recent  and  the  experiments  too  limited  to  war- 
rant any  very  definite  conclusions  or  recommenda- 
tions. Subcutaneous  injections  are  said  to  have  ben- 
efited, while  intravenous  aggravated  the  condition. 

Serum  Therapy: — Remarkable  clinical  results  are 
claimed  by  both  Klemperers,  Fowdinsky,  and  Em- 
merich, with  anti-pneumococci  serum.  The  serum 
treatment  has  not  been  more  generally  adopted  in 
pneumonia  on  account  of  the  difficult\^  of  obtaining 
the  serum  from  immunized  rabbits.  Whatever  may 
be  the  value  of  serum  therapy,  it  has  not  yet  passed 
beyond  the  stage  of  experimentation. 


POWDER  STAINS. 

Stains  due  to  gun  powder  may  be  removed,  ac- 
cording to  Shoemaker,  b\^  first  washing  with  equal 
parts  of  Biniodide  of  Mercury  and  Distilled  ^A^ate^  ; 
this  causes  the  spots  to  become  red ;  then  apply 
Dilute  Hydrochloric  Acid  and  the  red  stains  will 
disappear.     (Sh.) 


32 


482         DIGEST   OF   EXTERNAL  THERAPEUTICS. 


PROCTITIS. 

The  patient  should  be  confined  to  bed  and  an}-  scj^- 
balse,  if  present,  must  be  cleared  away  by  injections. 

Cold  W^ater  Injections,  and  the  application  of 
Cold  to  the  anus,  will  usually  be  sufficient  for  mild 
cases.     (Gt.) 

Hot  Water  Injections : — May  be  employed  in  place 
of  cold,  and  are  generally  more  grateful.     (Bt.) 

Anodyne  Injections: — About  2  ounces  of  mucilage 
of  starch,  with  a  few  drops  of  Laudanum  (Tre.),  or 
decoctions  of  Althea.     (Al.) 

Suppositories  of  Iodoform,  gr.  v. ;  Ext.  Bella- 
donna, gr.  Vs,  are  very  useful.     (Tre.) 

Antiseptic  Injections: — Are  of  great  service,  espe- 
cialW  if  the  disease  is  specific,  viz.:  Solutions  of  Boric 
Acid;  Mercuric  Bichloride,  1-10,000  (not  stronger); 
Carbolic  Acid,  1-100. 

Nitrate  of  Silver: — If  the  disease  does  not  \'ield^ 
w^eak  solutions  of  gr.  ss-gj  may  be  injected,  increas- 
ing the  strength  later  four  or  five  times  as  indicated. 
(L.  T.)  A  solution  of  gr.  v-3J  painted  on  through 
the  speculum,  is  recommended  in  chronic  forms,  or 
as  an  injection  in  the  strength  of  gr.  iij-.lj.  When 
the  disease  is  extensive  the  latter  should  be  followed 
by  copious  injections  of  warm  water.  Applications 
as  injections  should  not  be  made  more  frequently 
th an  ever}'  third  day .     ( K . ) 

Astringent  Injections : — These  are  usefiil  in  chronic 
forms.  In  addition  to  nitrate  of  silver,  the  following 
are  employed  when  the  discharge  is  very  fetid : 

9:.    Liq.  Bismuthi,  ^ij. 

Glycerit.  Amyli,  ^ij. 

M.  (Tre.) 


PROSTATE,  HYPERTROPHY  OF.        483 


Or, 

9;.    L,iq.  Carbon.  Deterg., 

3ij- 

Tr.  Krameriae, 

3iv. 

Mucil.  Amyli, 

ad  ^iv. 

M. 

Inject  g  j  nigTit  and  morning. 

(Tre.) 

Other  useful  astringents  are :  Alum,  gss-j-Oj  ;  Tan- 
nin, 1  to  2  per  cent,  solution;  Zinc  Sulphate,  gr,  xv- 
gj;  Infus.  Hydrastis,  gj-Oj. 


PROSTATE,  HYPERTROPHY  OF. 

Guard  against  exposure  and  sudden  chilling,  al- 
ways protect  the  limbs  and  feet  when  arising  to  uri- 
nate at  night.  A  warm  and  equable  climate  is  of 
great  benefit.  Over-distension  of  the  bladder  should 
never  be  permitted.  Horseback  riding  and  excesses 
of  all  kinds  should  be  avoided. 

The  passage  every  fifth  day  of  a  full-sized  conical 
Steel  Sound  or  the  local  application  to  the  prostatic 
urethra  of  a  solution  of  Nitrate  of  Silver,  1  to  3 
grains  to  the  ounce  with  a  Keyes-Ultzman  capillary 
of  allsyringe,  gives  good  results.     (CI.) 

Catheterization: — Often  necessary  to  remove  resid- 
ual urine,  especially  w^hen  atony  of  the  bladder  ex- 
ists. It  may  be  employed  before  retiring  in  order  to 
give  a  better  night's  rest,  and  may  also  be  required 
during  the  day.  In  some  instances  it  will  be  neces- 
sary to  use  Mercier's  catheter  ^with  one  or  two 
elbows,  or  an  English  catheter  moulded  to  an  exag- 
gerated curve  by  placing  in  hot  water,  then  cooling 
in  ice  water;  quickly  introduced  with  stylet  re- 
moved, this  ^vill  frequently  succeed  in  entering  the 


484  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

bladder.  If  cystitis  exists  the  bladder  should  be 
washed  out  with  an  antiseptic  solution.  Catheters 
should  receive  strict  antisepsis.     (Cln.) 

Bottini's  Gal vano- Cautery  Incision: — This  method 
consists  in  burning  one  or  more  grooves  through  the 
obstructing  portion  of  the  prostate  by  the  galvano- 
cautery.  Freundenberg's  modification  of  Bottini's 
incision  renders  the  procedure  thoroughly  aseptic 
and  entirely  under  the  control  of  the  operator.  This 
instrument  is  described  as  follows:  "It  consists  of  a 
shaft  shaped  like  a  lithotrite,  provided  with  a 
platino-iridium  blade,  or  a  male  shaft  which  is  con- 
nected directly  with  a  storage  battery,  or  with  a 
street  alternating  current  of  104  volts  by  means  of 
the  cautery  transformer,  controlled  wnth  an  ampere- 
meter, and  concealed  w^hen  the  blade  is  closed  within 
the  female  blade.  The  platino-iridium  blade  is  ex- 
posed by  turning  the  wheel  attached  to  the  Archi- 
median  screw  to  the  right,  the  scale  on  the  exposed 
shaft  behind  the  w^heel  exactly  gauging  the  length 
the  male  blade  is  exposed  or  the  length  of  the  groove 
made  in  the  prostatic  tissues.  The  incisor  is  pro- 
vided with  a  cooling  apparatus,  which  runs  through 
the  entire  length  of  the  shaft,  crossing  at  the  beak 
and  returning  on  the  opposite  side  of  the  instrument. 
The  entrance  and  exit  of  the  w^ater  canals  are  di- 
rected downward  and  inward.  To  one  is  attached  a 
piece  of  rubber  tubing,  which  supplies  cold  Avater 
from  a  reservoir  and  to  the  other  a  similar  piece  of 
tubing,  which  conveys  the  water  to  a  receiver. ' ' 

Before  operating  it  is  very  important  to  examine 
the  bladder  thoroughly  with  the  cystoscope,  and 
with  Thompson's  stone  searcher,  in  order  to  ascer- 
tain w^hether  or  not  a  stone  is  present,  and  to  deter- 


PROSTATITIS.  485 

mine  the  relative  size  of  the  middle  and  lateral  lobes 
of  the  prostate. 

Excellent  results  are  obtained  from  the  Bottini- 
Freundenberg  method.  It  is  not,  how^ever,  free  from 
danger,  and  is  contra-indicated  when  the  kidneys  are 
involved.  Sepsis  from  opening  a  pocket  of  pus  in  the 
prostate  and  pulmonary  thrombosis  must  be  con- 
sidered as  possible  dangers.  When  cystitis  or  pyelitis 
are  present,  both  local  and  internal  antiseptic  medi- 
cation should  precede  the  operation.  (The  details 
and  technique  of  application  are  fully  described  by 
Dr.  B.  G.  Carleton,  in  the  N.  Y.  Med.  Times,  Dec, 
1898.) 

Rectal  Tamponade  and  injections  of  Cocaine  into 
the  parenchyma  of  the  testicles  to  produce  atrophy 
have  their  advocates. 


PROSTATITIS. 

ACUTE  PROSTATITIS. 

Rest  in  bed.  Hot  Sitz  or  General  Baths,  Fomenta- 
tions to  perineum,  Rectal  Douches  of  hot  or  cold 
water,  injected  against  the  prostate  by  means  of  a 
rectal  psychophore,  or  by  enemata  of  from  two  to 
four  quarts  of  water,  several  times  a  day  are  effect- 
ive measures.     (Cln.) 

Anodyne  suppositories,  containing  Belladonna, 
Hyoscyamus,  or  Opium,  such  as  the  following: 

9;.    Ext.  Opii,  gr.  j. 

Ext.  Hyoscyanii,  gr.  ss. 

Ol.  Cocois,  q.  s. 
M. 


486  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Or, 

5fc.    Ext.  Belladonnae,  gr.  }(. 

Ol.  Cocois,  q.  s. 

M.  (Sn.) 

Leeches : — Applied  to  the  perineum  are  recom- 
mended by  some  authorities  when  there  is  much 
throbbing  and  pain.     (Al.) 

Catheterization: — If  there  is  retention,  the  urine 
must  be  drawn,  instrumentation  being  preceded  by 
a  douche  of  a  2  per  cent,  solution  of  Cocaine. 

Incision: — When  an  abscess  forms  it  must  be 
opened  in  the  perineum  in  order  to  avoid  ischio- 
rectal fistula.  If  it  becomes  necessary  open  the  ab- 
scess in  the  rectum,  make  a  punctured  incision  and 
keep  the  rectum  aseptic  as  much  as  possible  by  fre- 
quent Carbolic  Douches.  After  antiseptic  douching 
the  cavity  of  the  abscess  may  be  distended  with  a 
w^arm  emulsion  of  Iodoform  in  vaseline  in  the 
strength  of  10  per  cent.,  which  v^ill  give  excellent 
results.  If  an  abscess  opens  into  the  urethra,  the 
canal  should  be  irrigated  twice  a  day  with  a  satur- 
ated solution  of  Boric  Acid  or  a  solution  of  Nitrate 
of  Silver,  1-2000.     (Cltn.) 

Cold  Sitz  Baths: — Of  tw^enty  to  thirty  minutes, 
daily  at  bed  times. 

Suppositories  of  Iodoform  or  Ichthyol,  containing 
each  about  2  grains,  have  proved  beneficial.  Cleanse 
the  rectum  first  with  a  douche  before  inserting. 
(Cln.) 

Tannate  of  Glycerine  : — Applied  to  the  inflamed 
point  in  the  urethral  canal  by  means  of  a  deep  ure- 
thral syringe  is  said  to  have  good  effect.     (Al.) 

Kemp's  rectal  cooler  is  also  of  service  for  appljang 
cold  to  the  prostate. 


PROSTATITIS.  487 

CHRONIC  PROSTATITIS. 

Rest  in  the  recumbent  position  and  evacuation  of 
the  bowels  daily  by  Enema  are  important  factors  of 
treatment. 

The  passage  of  Cold  Steel  Sounds  is  very  effica- 
cious ;  a  full-sized  sound  should  be  selected  and  passed 
with  the  utmost  gentleness  and  ease,  or  it  will  be 
arrested  by  the  compressor  urethras,  w^hich  is  usually 
in  a  condition  of  spasmodic  contraction.  The  sound 
should  be  passed  every  five  or  eight  days.  In  some 
cases  a  Carleton's  or  Kollman's  antero-posterior 
urethra  dilator  may  be  used.     (Cln.) 

The  Psychrophore : — As  some  attribute  the  good 
results  from  the  use  of  the  sound  to  the  cold,  the 
passage  of  a  hollow  instrument  through  which  cold 
water  is  caused  to  flow,  left  in  position  for  about 
five  minutes,  is  also  employed.     (CI.) 

Nitrate  of  Silver: — 2  to  3  drops  of  a  solution,  gr. 
J-X-5J,  applied  by  means  of  the  Keyes-Ultzman  capil- 
lary syringe,  may  be  used  when  the  mucous  mem- 
brane is  seriously  affected,  as  shown  by  the  discharge 
of  round  masses  from  the  lacunae  of  the  glands.    (CI.) 

In  many  cases  the  application  of  this  remedy  to 
the  prostatic  urethra  will  be  attended  with  benefit. 
Commence  wnth  a  few  drops  of  a  1  per  cent,  solution 
and  gradually  increase  to  2,  3,  4,  and  5  per  cent,  as 
toleration  is  established.  Unduly  strong  solutions 
will  cause  intense  reaction.  The  solutions  should  be 
accurately  placed  in  the  prostatic  portion  of  the 
urethra.  This  may  be  accomplished  by  introducing 
a  catheter  and  thus  ascertaining  the  point  at  w^hich 
the  urine  begins  to  flow;  with  the  length  of  the 
urethra  known  there  will  be  no  difficulty  in  making 


488  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

the  application.  The  appHcations  should  not  be  ap- 
plied more  frequently  than  once  in  three  days  or  once 
a  week.     (B.  H.) 

Massage  of  the  Prostate:— The  patient  should  be 
placed  in  the  dorsal  position  with  the  limbs  slightly 
flexed  or  in  the  knee  and  elbow  position.  The  finger 
of  the  operator,  protected  bj^  a  long  rubber  tip  and 
anointed  with  vaseline,  is  inserted  into  the  rectum. 
The  diseased  gland  is  massed  from  right  to  left  and 
the  reverse.  The  tip  of  the  finger  should  also  be  em- 
ployed to  press  the  gland  forward  toward  the  sym- 
physis, and  a  forward  and  backward  massage  move- 
ment made.  This  procedure  should  be  continued 
from  two  to  five  minutes  and  may  be  repeated  every 
fifth  day.  In  some  cases  it  is  advisable  to  introduce 
a  full  sized  steel  sound  into  the  urethra,  and  retain  it 
during  massage.  Massage  by  Feleke's  or  Swin- 
burne's instruments  is  not  advised.     (Cln.) 

Cantharidal  Collodion: — Is  advised  by  some  writ- 
ers; one  side  of  the  perineum  is  painted  up  to  the 
raphe  and  the  patient  is  kept  in  bed ;  when  the  part 
has  healed  the  other  side  is  painted.  The  anus  and 
scrotum  must  be  protected.     (CI.) 


PRURIGO. 

The  first  aim  of  treatment  is  to  improve  the 
hygienic  surroundings  of  the  patient  and  to  employ 
liberally  soap,  water,  and  clean  clothing. 

Pilocarpine  Muriate: — On  account  of  its  action  on 
the  sweat  glands,  has  a  powerful  effect  on  the  gen- 
eral condition  and  may  be  regarded   as  a  reliable 


PRURIGO.  489 

remedy.  It  may  be  administered  hj^podermically^ 
but  in  small  doses,  for  fear  of  collapse.     (B.  H.) 

Baths : — Plain  or  alkaline,  are  xery  generally  em- 
ployed, followed  by  ointments  or  lotions,  viz.: 

Unna's  ointment  acts  favorabl^^  It  is  composed  of 
Zinc  Oxide  Ointment,  100  parts.  Carbolic  Acid,  5 
parts,  Corrosive  Sublimate,  %  to  ^^  part. 

"Wilkinson's  Ointment: — Hebra  recommends  the 
following  modification  of  Wilkinson's  ointment : 

9(.    Flor.  Sulphuris, 

Ol.  Cadini.,  aa  ^vj. 

Sap.  Viridis, 

Adipis,  aa  Oj. 

Cretae,  ^  iv. 

M.  (And.) 

Anderson  recommends  Plain,  "Warm,  Vapor,  or 
Turkish  Baths,  followed  by  friction,  and  the  use  of 
the  following  ointment : 

^.    Sulphuris, 
Glycerini, 

01.  Rusci,  aa  gvj. 

Ung.  Rumicis,  ,^ij. 

M. 

Vlemingckx's  Solution: — Followed  by  hot  baths^ 
are  also  advised.     (Hy.) 

The  following  other  remedies  may  be  mentioned  as 
effective : 

Tar  Ointment,  Sodium  Thiophene-Sulphonate,  So- 
dium Sulphophenate,  5  to  10  per  cent,  ointment; 
Hebra's  Soap  Treatment,  as  for  eczema,  all  consti- 
tute useful  remedial  measures. 

Naphthol: — 2  to  5  per  cent,  solution,  according  to 
age,  rubbed  in  every  night  in  conjunction  with  a 
bath  of  naphthol  soap  every  second  night.     (Ja.) 


490  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Tumenol : — A  10  per    cent,    solution    made    with 
equal  parts  of  alcohol,  glycerine  and  water.     (Al.) 


PRURITUS. 

External  treatment,  though  of  little  effect  in  cur- 
ing, is  of  great  benefit  in  relieving.  When  the  disease 
covers  the  whole  surface  of  the  body,  baths  will  be 
found  of  service.  Linen  underwear,  over  which  flan- 
nel can  be  worn,  agrees  w^ith  some,  while  others 
prefer  silk.  A  great  number  of  remedies,  of  which 
the  following  are  the  most  important,  are  employed 
for  the  relief  of  this  intractable  affection : 

Carbolic  Acid: — One  of  the  most  effective  applica- 
tions, it  generally  be  tried  first.  It  may  be  employed 
in  strengths  varying  from  5  to  20  grains  to  the 
ounce  or  in  the  follow^ing  combinations : 

Carbolic  Acid,  20  parts. 

Glycerine,  75  parts. 

Alcohol,  25  parts. 

Distilled  Water,  300  parts. 

I  to  4  tablespoonfuls  in  a  tumbler  of  hot  water  ;  bathe  parts. 

(T.,  98.) 

Combined  with  Creoline,  it  will  be  found  useful  in 
the  follow^ing  proportions : 

Carbolic  Acid,  2  parts. 

Creolini,  3  parts. 

Cologne  Water,  100  parts. 

(T.  C,  Vol.  V.) 

A  solution  in  alcohol,  1  to  2  drachms  to  the  ounce, 
is  recommended.  Mop  the  skin  gently,  but  do  not 
rub  in.    A  spray  the  strength  of  half  an  ounce,  to 


PRURITUS.  491 

water  1  pint,  and  glycerine  1  ounce,  with  5  to  10 
minims  of  oil  of  peppermint  added,  is  also  useful. 
(Ja.) 

The  fact  that  the  skin  of  some  persons  is  much 
more  sensitive  and  liable  to  irritation  than  others 
must  be  taken  into  consideration  before  employing 
the  stronger  solutions.  An  ointment  being  some- 
times preferable,  the  following  will  be  found  useful : 

9;.    Acid.  Carbolici,  gr.  xv-xx. 

Ung.  Zinc.  Oxidi,  5J- 

M. 

Menthol: — Used  in  various  strengths;  an  alcoholic 
solution  containing  10  per  cent,  acts  well.  (F.)  In 
severe  forms  a  solution  of  50  grains  to  the  ounce  of 
olive  oil  has  proved  effective  (Al.);  or  combined  with 
cocaine,  viz.: 

9f.    Mentholi,  3j. 

Cocain.  Hydrochloratis,  gr.  xx. 

Alcoholis,  gj. 

Aqu£e  Sj. 
M. 

Cocaine: — 2  parts  with  lOQ  of  flexible  collodion,  or 
a  solution  of  20  per  cent,  with  5  of  glycerine.    (F.) 

Brucine: — Acts  somewhat  like  cocaine  and  has 
been  satisfactorily  employed  in  20  per  cent,  solu- 
tions.    (F.) 

Chloroform: — 1  drachm,  olive  oil,  1  ounce,  will 
allay  the  itching  of  urticaria  and  pruritus  (F.),  or  1 
drachm  with  1  pint  of  alcohol.     (B.  H.) 

Ichthyol: — Will  prove  useful,  though  it  makes  a 
disagreeable  application,  viz.: 

^.    Ichthyoli,  5j. 

Spts.  Villi, 

Etheris,  aa  '^v. 

M.  (T.,  97.) 


492    DIGEST  OF  EXTERNAL  THERAPEUTICS. 


Bulkley  recommends  the 

following : 

9;.    Ichthyoli, 
Ung.  Picis, 
Zinc.  Oxidi, 

33- 

3ij. 

Ung.  Aq.  Rosae, 
M. 

5"j 

Or, 

^.    Ichthyoli, 
Ol.  Cadini, 

Ol.  Gossypii, 
Sig.     Use  diluted  with  oil. 

aa  3j. 

Camphor: — Useful  in  the  form  of  the  spirits,  pow- 
der or  ointment,  or  combined  w^ith  Chloral  by  tri- 
turation of  equal  parts,  forming  the  well  known 
glycerine  like  mixture.  An  ointment  is  composed  as 
follows : 

^.    Camphorse, 

Chloralis,  aa  3J. 

Ung.  Aq.  Rosae,  ^j. 

M.  (Vn.) 

Camphor  may  be  combined  effectively  w^ith  Borax 
as  follows : 

9;.    Spts.  Camphorse,       '  Jss. 

Sod.  Boratis,  ^ij. 

Glycerini,  |ij. 

Aquae,  ^vj. 

M. 

Sig.     To  be  well  shaken  before  applying.     (A.  C.  S.,  8,  77.) 

It  may  also  be  mixed  with  Potassium  Sulphuret  in 
the  following  proportions : 

9;.    Potass.  Sulphureti,  giij. 

Spts.  Camphorae,  ,^ss. 

Glycerini,  5J. 

Aquae,  q.  s.  ad   ^vj. 

M. 

Sig.     Apply  by  the  medium  of  a  saturated  strip  of  lint.    (Hy. 


PRURITUS.  493 

These  preparations  should  not  be  used  on  the 
broken  skin. 

Opium: — In  the  following  ointment:  Opium,  8 
grains,  creosote,  10  drops,  vaseline,  2  ounces;  (Ga.) 
or  in  the  form  of  morphine  in  the  proportion  of  1 
grain  to  the"  ounce,  added  to  the  two  compound 
camphor  lotions  above,  may  be  employed  when  ano- 
dyne lotions  are  desired.     (Hy.) 

Pilocarpine: — Simon  has  successfully  employed  this 
remedy  hypodermically  in  doses  of  ^  of  a  grain  of  the 
muriate.     (Hy.) 

Alkaline  Lotions  : — Bicarbonate  of  Soda,  5J— Oj  ; 
Borax,  saturated  solution  in  rose  water;  Lime 
Water,  pure,  or  in  the  following  combination  is  es- 
pecially useful  for  the  itching  of  eczema  and  other 
inflammatory  conditions  of  the  skin,  also  in  senile 
pruritus : 

T^.    Liq.  Calcis,  5iij. 

Creosoti,  M.  x. 

Pulv.  Zinc.  Carb.  (Impure),  gj. 

Glycerini  vel  Ol.  Olivae,  5"j- 

M.  (Sm.) 

Losophen: — 1  to  2  per  cent,  in  a  mixture  of  3  parts 
of  alcohol  and  1  part  of  water,  apply  two  or  three 
times  a  day.  In  some  cases  this  will  prove  irritat- 
ing; an  ointment  of  1  to  3  per  cent,  is  also  used.  (F.) 
The  following  is  recommended  in  dry  itching  in- 
flammatory affections  of  the  skin : 

Talc,' 

Powdered  Starch,  each    5  parts. 

Glycerine,  20  parts. 

Lead  Water,  100  parts. 

This  is  to  be  diluted  with  twice  the  volume  of  water,  shaken  and 
applied  to  the  skin  and  allowed  to  dry.  When  the  skin  is  broken, 
half  the  lead  water  may  be  replaced  by  a  i  per  cent,  solution  of  boric 
acid  The  lotion  is  contra-indicated  when  there  is  a  full  discharge. 
<T.,98.) 


494  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Among  some  of  the  useful  powders  are  the  follow- 
ing: 

Talc, 

Oxide  of  Zinc,  each    5  parts. 

Salicylate  of  Bismuth,  10  parts. 

Rice  Starch,  90  parts. 

Borax,  2  parts. 

Talc,  10  parts. 

Oxide  of  Zinc,  30  parts. 

Rice  Starch,  60  parts. 

(T.  C,  Vol.  V.) 

Medicated  Baths: — These  will  at  times  afford  re- 
lief; the  following  will  be  found  of  service: 

Sodium  bicarbonate,  gviij— §x,  water,  30  gallons; 
nitric  or  hydrochloric  acid,  §j,  w^ater,  30  gallons. 
Starch  baths,  followed  by  sponging  with  aromatic 
vinegar  250  parts,  and  carbolic  acid  5  parts.  Sul- 
phur baths  also  are  sometimes  useful.  After  the 
bath  the  patient  should  be  dried  b3^  wrapping  in 
warm  sheets,  followed  by  a  vigorous  patting  of  the 
skin,  anointing  same  with  some  bland  oil  and  pow- 
dering with  starch. 

Acid  Lotions: — Viz.:  Vinegar,  Lemon  Juice,  pure 
or  diluted,  and  solutions  of  Dilute  Hydrochloric 
Acid  are  said  to  relieve  the  itching  of  urticaria. 

Tannin : — Squibb's  formula  is  as  follows : 

1^.    Acid.  Tannici,  9j. 

Glycerini, 

Spts.  Vini  Rect.,  aa  ^ss. 

Aq.  Destill.,  ad  ^iv. 

M. 
Sig.     Apply  morning  and  evening. 

The  following  are  among  the  almost  endless  num- 
ber of  remedies  which  have  been  advised  for  this  con- 
dition : 


PRURITUS. 

¥t. 

^5-NaphthoH, 
Retinoli, 

9j. 

Sapo.  Mollis, 

aa  gr.  cc. 

Pulv.  Cretse  Preeparatae, 

9ij. 

M. 

¥t. 

Ess.  Gaultheriae, 

3SS. 

Thyuioli, 

3J- 

Resorcini, 

3iv. 

Aq.  Coloiiiensis, 

5vj3ij 

495 


M. 

Mercuric  Bichloride: — Gr.  ss— §j. 

Burow's  Liquor: — (See  Appendix  II.) 

Resorcin: — Gr.  x— xx— 5J. 

Tumenol,  a  10  per  cent,  alcoholic  or  aqueous  solu- 
tion. Also  lotions  of  Hamamelis,  Dilute  Aqua  Am- 
monise,  Tar  \A^ater  and  Goulard's  Solution. 

Liq,  Picis  Alkalinus: — 

9(.    Picis  L/iquidae,  ^ij. 

Potass.  Causticae.  3J. 

Aquae,  3  v. 

M. 
Dissolve  the  potash  in  water  and  gradually  add  to  the  tar  with 
rubbing  in  a  mortar.     Dilute  for  use  in  the  proportion  of  i  to  2 
drachms  to  a  pint  of  water,  gradual!}-  increasing  the  strength. 

PRURITUS  ANI. 

Removal  of  cause  when  it  can  be  ascertained,  such 
as  hgemorrhoids,  fissure,  eczema,  ulcer,  polypi,  ascar- 
ides,  etc.,  is  the  first  essential  of  treatment.  Many- 
causes,  however,  are  unattended  w^ith  any  discerni- 
ble pathological  change,  and  palliative  treatment  is 
necessary.  Applications  may  be  made  in  the  form  of 
lotions  or  ointments,  as  a  rule,  the  latter  are  prefer- 
able. Of  the  numerous  remedies  for  this  condition 
the  following  are  w^orthy  of  mention: 


496  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Hot  ^Vate^: — Applied  as  hot  as  can  be  tolerated 
with  soft  cloth  or  b\'  sitting  over  a  pail  of  hot  water 
and  sopping  the  parts;  drj^  genth'  b^'  patting  the 
skin,  and  dust  with  starch  powder. 

Carbolic  Acid: — One  of  the  most  effective  agents. 

^.    Acid.  Carbolici,  3^- 

Glycerini,  gj. 

Aq.  Destill.,  5"j- 

M.  (K.) 

Sig.     Dilute  if  too  strong;  apply  at  night. 

Alum  and  Zinc  Sulphate: — Equal  parts  of  each 
placed  in  an  earthen  vessel  and  heated  until  they  be- 
come a  hard  mass ;  of  this  half  a  drachm  is  powdered 
in  a  little  water  and  throvim  into  the  rectum  every 
night ;  in  a  few  minutes  it  will  dispel  the  itching,  and 
will  succeed  when  other  drugs  have  failed.  It  is  espe- 
cially indicated  when  there  is  engorgement  of  the 
haemorrhoidal  veins.     (Al.) 

Campho-Phenique  : — Equal  parts  with  Zinc  Oint- 
ment, is  highh'  praised  (Al.),  or  5]  to  water  §j  after 
bathing  in  A^ery  hot  water.  (Mc.)  Another  useful 
formula  is : 

Campho-Phenique,  33. 

Losophen,  gr.  xx. 

Cosmoline,     ,  ^j. 

(T.,98.) 

Salicylic  Acid: — 3v— §j,  will  often  afford  great  re- 
lief.    (Al.) 

Cocaine  and  Menthol: — Combinations  are  effective. 
(See  Pruritus.) 

Nitrate  of  Silver: — A  solution  of  gr.  xvj  in  Nitrous 
Ether  Qa.),  or  gr.  xx,  water,  3J,  painted  on  will 
cause  pain,  but  will  afford  immediate  relief.    (Gt.) 

Bulkley's  Antipruritic  Powder  is  very  satisfactory ; 


PRURITUS.  497 

it  is  composed  of  1  drachm  each  of  Camphor  and 
Chloral,  rul3bed  together  until  liquified,  then  mixed 
with  1  ounce  of  starch. 

Tr.  Sapo.  Vir.:— When  there  is  thickening  of  the 
skin  from  effusion  this  is  indicated. 

The  following  combination  also  acts  well ; 

T^.    Sapo.  Viridis, 

Ol.  Cadini, 

Alcoholis,  partes  equales. 

M. 
Sig.     Apph-  once  a  day. 

This  is  effective  but  more  disagreeable  than  green 
soap. 

Applications  of  green  soap  should  be  followed  by 
soothing  ointments.     (K.) 

Brocq  employs  as  a  soothing  ointment  Zinc  Oxide 
and  Vaseline,  followed  by  this  powder: 

Powdered  Camphor,  2  parts. 

Zinc  Oxide,  30  parts. 

Bismuth  Subnitrate,  30  parts. 

Chalk,  •  40  parts. 

(T.,98.) 

Lead  Acetate : — The  following  is  used  at  St. 
Mark's  Hospital,  London : 

Solution  of  Lead  Subacetate,  i  part. 

Fresh  Milk,  7  parts. 

Add  the  milk  to  the  lead  by  degrees,  at  the  same  stirring;  apply 
on  cotton  and  retain  in  place.     (T.,  98.) 

Collodion: — May  be  painted  on  as  a  protective 
w^hen  eczema  and  excoriations  are  frequent. 

Tar  Ointments: — These  are  generally  soothing  and 
are  indicated  v^hen  eczema  exists. 

The  following  are  suggested,  Ung.  Picis.  painted 
on  (T.,  98),  or: 

33 


498  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

9;.    Ung.  Picis,  5iij. 

Ung.  Belladonnae,  jij. 

Tr.  Aconiti  Rad.,  •  Jss. 

Zinc.  Oxidi,  5J. 

Aq.  Rosae,  f  iij. 

M.  (Mc.) 

Tr.  Iodine  (Churchill's): — A  painful  but  ver\'^  effect- 
ive remedy.     (Gt.) 

The  following  is  recommended,  to  be  injected 
daily : 

5t.    Fid.  Ext.  Hamamelidis,  gj. 

Ext.  Ergotae,  ^ij. 

Ext.  Hydrastis,  jij. 

Tr.  Benzoin.  Comp.,  jij. 

Ol.  Olivae  Carbolat.  (5  per  cent.  Carbolic 
Acid),  gj. 

M. 

Sig.     Shake  well  before  using;   i  to  2  drechms  for  injection. 

(B.  H.) 

An  ointment  of  Dr.  I.  V.  Shoemaker's  is: 

^.    Sulphur.  Prsecipitati,  ^j. 

^^-Naphtholi,  gr.  x. 

Morph.  Sulphatis,  gr.  ss. 

Bismuth.  Subnitratis,  gss. 

Ung.  Zinc.  Oxidi,  5^ss. 
M. 

Two  formulse  commended  by  Kelsej-  for  use  in  ob- 
stinate cases  are  as  follows : 

J^.    I/iq.  Carbonis  Deterg.  (Wright's), 

Glycerini,  aa  ^j. 

Pulv.  Zinc.  Oxidi, 

Calamin.  Prseparatae,  aa   Jss. 

Pulv.  Sulph.  Praecipitati,  ^ss. 

Aq.  Destill.,  ad   ^vj. 

M. 
Sig.     To  be  painted  on  once  or  twice  a  day  and  allowed  to  dry. 


PRURITUS. 
9;.    Sod.  Boratis, 

3ij- 

Morph.  Sulphatis, 

gr.  XV j 

Acid.  Hydrocyanic.  Dil., 

gss. 

Glycerini, 

^ij. 

Aq.  Destill., 

ad  ^viij. 

M. 

Sig.     Apply  4  or  5  times  in  twenty- 

■four  hours. 

499 


Borax: — Forms  an  excellent  soothing  application ; 
the  powder  dusted  on  the  raw  surfaces,  kept  sepa- 
rated by  soft  gauze,  is  used  with  good  effect  when 
moist  eczema  is  the  cause,  a  condition  in  which  mild 
dry  dressings  are  indicated.  (Gt.)  In  other  cases  a 
saturated  solution  acts  w^ell. 

Dilute  Sulphurous  Acid: — After  cleansing  the  parts 
with  soap  suds  this  is  said  to  afford  quick  relief  in 
cases  of  eczema  marginatum.     (Gt.) 

Suppositories  containing  Belladonna,  Cocaine,  or 
Creosote  give  relief  in  cases  when  the  parts  are  ex- 
coriated ;  when  this  condition  exists  Menthol,  Pep- 
permint, and  Chloral  should  not  be  employed.     (Ja.) 

Forcible  Divulsion: — When  no  local  cause  can  be 
detected  this  measure  has  given  satisfactory  results 
in  conjunction  w^ith  the  removal  of  redundant  skin 
by  cutting  and  scraping ;  it  is  recommended  in  cases 
w^hich  have  resisted  all  other  means. 

PRURITUS  SCROTI. 

Manj^  of  the  remedies  mentioned  under  the  general 
head  of  pruritus  are  applicable  to  the  disorder  in  this 
locality.  In  addition  the  foUow^ing  have  proved  sat- 
isfactory : 

Picric  Acid: — 1  to  5-1000,  has  succeeded  w^hen 
other  applications  have  failed. 

Phenol: — 20  grams,  glycerine  75  grams,  alcohol  25 


500  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

parts,  and  water,  300  grams ;  1  part  of  this  mixture 
is  diluted  with  4  of  hot  water  and  apphed  by  means 
of  saturated  gauze.     (T.,  97.) 

Pyroligneous  Acid: — 1  part  to  30  of  water  or  gly- 
cerine, or  an  ointment  gradually  increased  in 
strength,  is  recommended  by  Piffard. 

PRURITUS  VULV^. 

Washing  the  parts  wdth  soap  and  water,  then  with 
a  Sublimate  Solution,  following  with  applications 
of  Carbolized  Vaseline,  3  to  5  per  cent.,  often  proves 
successful.     (T.,  97.) 

Hot  W^ater  Sponging: — Using  the  water  hot  as  it 
can  be  borne  is  excellent  and  should  be  tried  in  all 
cases.     (Vn.) 

Nitrate  of  Silver: — A  2  per  cent,  solution  is  highly 
effective. 

The  following  method  is  recommended:  Admin- 
ister a  vaginal  injection  every  night  of  a  solution  of 
Lysol,  followed  by  one  of  Boiled  W^ater,  and  lastly 
by  one  of  Mercuric  Bichloride.  Wash  the  vulva 
with  care  and  introduce  between  the  labia  a  fold  of 
muslin  v^et  with  a  solution  of  Tannin  5ss— Oj.  Ex- 
coriations may  be  touched  with  Nitrate  of  Silver, 
(T.,  96.) 

Cocaine  Hydrochlorate: — May  be  employed  with 
good  effect  w^hen  the  affection  appears  to  start  from 
the  clitoris  and  is  attended  with  nervous  crisis,  viz.: 

$fc.    Cocain.  Hydrochloratis,  3J. 

Acid.  Borici,  Siij- 

M. 
Sig.     Dust  on  the  clitoris  and  underiying  parts. 

Instant  but  only  temporary  relief  will  be  obtained. 


PRURITUS.  501 

Tannaform : — 1  part,  starch,  4  parts,  for  diabetic 
pruritus.     (F.) 

The  following  are  useful  applied  with  saturated 
compresses : 


«fc. 

Fid.  Ext.  Grindeliae, 

^ss. 

Creolini, 

3ij- 

M. 

Aquse, 

q.  s.  ad  ^v. 

Or, 

|fc. 

Potass.  Bicarbonatis, 

3ij- 

Aquae, 

Oj. 

(Sm.) 
Veratrine: — In  the  proportion  of  3  grains  to  the 

ounce  of  lard.     (Hy.) 
Hydrocyanic  Acid: — Used  in  severe  cases,  but  with 

caution,  and  never  where  the  skin  is  abraded,  viz.: 

5fc.    Acid.  Hydrocyanic.  Dilut.,  3ij. 

Sodii  Boratis,  3J. 

Aq.  Rosae,  §viij. 
M.  (Sn.) 

^.    Bismuth.  Subnitratis,  ^ij. 

Acid.  Hydrocyanic.  Dilut.,  3J. 

Mist.  Amygdalae,  ^iv. 
M.                    '  (And.) 

Emollient  poultices,  such  as  fresh  Almond  Meal, 

sprinkled  with  Boric  Acid,  will  prove  soothing;  also 

the  following  lotion  painted  on  parts : 

1^.    Sodii  Sulphitis,  3J. 

Glycerini,  ^j. 

Aquae,  ^iv. 
M.  (B.  H.) 

Though  ointments  are  rarely  used,  the  following 
may  occasionally  prove  of  service: 
9;.    Hydrarg.  Chloridi  Mitis, 

Ext.  Belladonnae,  aa  3J. 

Ung.  Aq.  Rosae,  5i. 

M. 


502         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Injections  of  Zinc  Sulphate,  gr.  v— x— 3J  and  Bi- 
chloride of  Mercury,  1-4000.  used  on  alternate 
days,  with  bathing  of  the  external  genitals  once  or 
twice  daily  with  EichofTs  Sublimate  Soap,  consti- 
tutes a  useful  adjuvant  to  any  mode  of  treatment. 


PSORIASIS. 

Cleanliness  of  person  and  clothing  should  first  re- 
ceive strict  attention.  All  causes  tending  to  depress 
vitality,  as  excesses,  overwork,  relaxing  climate,  or 
other  drains  upon  the  s^^stem,  should,  if  possible,  be 
eliminated.  Local  measures^  are  of  great  importance ; 
they  are  of  two  classes ;  the  first,  those  used  to  re- 
move the  scales  to  prepare  the  way  for  the  second ; 
the  second,  those  which  exercise  a  directly-  curative 
effect  upon  the  diseased  skin,  and  so  prevent  the  re- 
newal of  the  scales. 

For  removal  of  the  scales  the  foUov^'ing  methods 
are  efiicacious : 

Alkaline  Baths,  Wet  Packing,  Inunctions  with 
oil,  vaseUne,  fat,  soft  soap,  and  even  caustics,  or  a  6 
per  cent,  solution  of  Salicylic  Acid  in  spirits.  The 
fats  or  oils  require  to  be  well  rubbed  in.  Many  cases 
get  well  with  one  of  the  above  methods  alone  if  per- 
severed in.  Continuous  Baths  in  tepid  water  have 
been  successful.  (Ck.)  Daily  Hot  Baths  and  the  use 
of  soap  and  a  nail  brush  should  be  emplo^'ed  in  all 
cases,  especially  when  the  disease  is  w4de-spread . 

The  following  alkaline  bath  may  be  resorted  to 
and  patient  allowed  to  soak  in  it  for  twenty  min- 
utes, after  which  scales  may  be  rubbed  of: 


PSORIASIS.  503 

Bicarbonate  of  Soda,  ^iij- 

Water,  at  temp,  of  95°  to  100°  F.,  C.  xxx. 

Much  depends  upon  the  thoroughness  with  which 
the  scales  are  removed. 

Sapo  Mollis  (Potash  Soap,  Black  Soap): — Rubbed 
on  night  and  morning  and  washed  off  as  seldom  as 
possible ;  highh'  prized  by  Hebra.     (Hb.) 

Mercurial  Ointments: — These  are  useful  when  only- 
mild  stimulants  can  be  tolerated,  viz.:  Hydrarg. 
Ammon.  gr.  x,  vaseline  §j,  or  Hydrarg.  Oxid.  Flav. 
in  the  same  strength,  or  these  two  mercurial  oint- 
ments combined,  or  Ung.  Hydrarg.  Nitrat.,  more  or 
less  diluted,  or  Hydrarg.  Biniodidi,  gr.  iij— x— |j ;  the 
latter  being  a  stronger  stimulant.     (Ck.) 

Chrysarobin: — This  is  the  best  application,  espe- 
cially when  it  is  desired  to  remove  the  patches  rap- 
idly. An  ointment  of  half  a  drachm  to  a  drachm  to 
the  ounce  ma\'  be  emplo^-ed,  though  it  is  better  in 
the  strength  of  about  5  per  cent.  Its  activity  is  in- 
creased by  the  addition  of  salicylic  acid  (3  per  cent.). 

A  paint  ^vhich  has  been  markedly  successful  is : 

5k.    Chrysarobini,  3J. 

Acid.  Salicylici,  jj. 

Liq.  Guttae  Perchae,  ^j. 
M.  (Kp.) 

This  remed}'  has  the  great  objection  of  staining 
everything  with  which  it  comes  in  contact,  dj^ng 
the  hair  orange  yellow^,  and  ruining  all  clothing.  It 
should  never  be  applied  on  the  face  or  scalp,  on  ac- 
count of  the  dermatitis  to  which  it  may  give  rise, 
and  the  danger  of  violent  conjunctivitis  should  any 
find  its  wa^'  into  the  eyes. 

The  following  solution  avoids  the  smearing  effect 
of  an  ointment : 


504  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

5t.    Chrysarobini,  3J. 

Collodii,  5j. 

j^ther.  et  Alcohol,,  aa  q.  s. 

M. 
Rub  the  chrysarobin  with  the  alcohol  and  ether,  and  add  the 
collodion.     It  will  result  in  an  emulsion,  which  should  be  shaken 
before  using  and  applied  with  a    brush  after  the  removal  of  the 
scabs.     (Ck. ) 

In  general  attacks  Unna's  Compound  Chrysarobin 
Ointment  (chrysarobin  5  parts,  salicylic  acid  2  parts, 
ichthyol  8  parts,  and  vaseline  90  parts)  is  effective 
and  speedj'^ ;  it  should  be  rubbed  in  after  a  bath.  If 
chrysarobin  produces  too  great  a  reaction  it  should 
be  discontinued,  and  starch,  vaseline,  or  an  alkaline 
wash  substituted.  It  stains  the  healthy  skin  a  deep 
mahogany,  and  leaves  the  patches  white ;  it  should 
be  continued  until  the  patches  are  affected  in  the 
same  w^ay.  These  effects  may  be  avoided  by  using 
Auspitz's  method,  viz.: 

Dissolve  gutta  percha  1  drachm  in  10  drachms  of 
chloroform,  to  this  add  1  drachm  of  chrysarobin, 
after  the  scales  are  removed  the  solutionis  painted 
on  and  forms  a  film.  It  is  renewed  every  two  or 
three  days. 

Besnier's  modification  of  the  above  is  to  paint  on 
a  solution  of  chrysarobin  in  chloroform,  and  then 
cover  it  with  the  chloroform  and  gutta  percha  var~ 
nish.    Both  methods  are  equally  efficacious.     (Ck.) 

Pyrogallic  Acid: — This  remedy  stands  next  to  the 
preceding  in  importance.  It  stains  everything  black, 
and,  on  account  of  its  poisonous  action  by  absorp- 
tion, is  not  suited  to  application  over  extensive  sur- 
faces. Its  action  is  less  inflammatory  than  that  of 
chrysarobin.  The  strength  of  its  application  is  a 
drachm  to  the  ounce  or  weaker.  (Vn.)    The  foUow^- 


PSORIASIS.  505 

ing  combination  has  been  productive  of  good  results 
in  cases  w^hich  have  resisted  other  treatment :  Pyro- 
gallic  acid,  salicylic  acid,  and  ichthyol,  each  3  parts, 
olive  oil  and  lanoline,  each  10  parts.     (T.,  97.) 

Tar: — Has  been  found  useful  in  various  forms,  and 
acts  Avell  when  there  is  much  itching.  Crocker  rec- 
ommends Oil  of  Cade,  half  a  drachm  to  the  ounce,  as 
an  ointment,  or  as  a  lotion  dissolved  in  spirits  with 
or  without  soft  soap,  equal  parts  of  each,  or  Liq. 
Carbonis  Detergens,  M.  x— 3j  and  upward.  He 
speaks  also  of  tar  baths  as  being  useful  remedies. 

The  following  is  also  a  convenient  mode  of  apply- 
ing this  remedy : 

V(.    01.  Rusci,  3ij. 

Etheris, 

Alcoholis,  aa  5ij. 

M. 

Filter  and  add  oil  of  lavender,  2  parts,  rub  in  at 
night,  and  wash  off  in  the  morning.  The  patient 
should  sleep  in  a  flannel  gown.     (Kap.) 

Thymol : — Introduced  some  years  ago  by  Crocker, 
forms  a  pleasant  and  suitable  application  for  the 
face,  being  more  cleanly  and  of  less  offensive  odor 
than  the  aforementioned  remedies.  An  ointment 
may  be  used  in  the  strength  of  15  grains  to  3L. 
drachms  to  the  ounce,  or  as  a  lotion  as  follows :. 

9:.     Thymoli,  5j. 

Liq,  Potassse,  3j. 

Glycerini,  gss, 

Aq.  Sambuci,  Sviij. 

M.  (Ck.) 

Naphthol: — This  remedy  is  of  equal  efficacy  w^ith 
thymol.  Kaposi  recommends  it  in  the  strength  of 
80    grains    to    the    ounce.      A    soap    containing    2 


506  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

drachms  of  the  remedy  to  the  ounce  of  green  soap 
has  been  found  to  act  well  in  cleansing  the  scalp,  and 
an  ointment  of  naphthol  3j ,  lard  5J ,  is  useful  for  re- 
moving the  scales  from  the  body.  If  used  over  an 
extensive  surface  it  may  induce  toxic  sj'^mptoms.  It 
may,  however,  be  regarded  as  an  excellent  remedy 
w^hen  for  any  reason  chrysarobin  or  pyrogallic  acid 
cannot  be  used.     (Al.) 

Sulphur: — Hebra's  modification  of  Wilkinson's 
ointment  often  proves  effective;  the  formula  is  as 
follows : 

9;.    Sulphur.  Sublimati, 

Ol.  Cadini,  aa  ^ss. 

Sapo.  Viridis, 

Adipis,  aa  ^j. 

Cretae  Praeparata:,  3iss. 

M. 

The  ointment  of  tar  and  sulphur  may  also  be  used 
combined  in  the  proportion  of  a  drachm  of  the 
former  to  an  ounce  of  the  latter.     (Guy's  Hospital.) 

An  ointment  of  sulphur,  10  to  30  grains  to  the 
ounce,  may  be  applied  to  the  scalp,  the  strength  de- 
pending upon  the  irritability  of  the  part.  (T.,  98.) 
Vlemingckx's  solution  (See  Acne  Simplex)  is  also  of 
service. 

Among  other  remedies  may  be  mentioned  Ammo- 
niated  Mercury  Ointment;  Solutions  of  Nitrate  of 
Silver  9ij— 5j,  recommended  by  Fox  in  chronic  cases 
(B.);  Gallacetophenone,  10  per  cent.;  Ichthyol,  5  to 
20  per  cent.;  Resorcin,  5  to  20  per  cent.  (B.  H.); 
Anthrarobin,  the  action  of  which  is  analogous  to 
that  of  chrysarobin;  and  Turpentine.  The  last  is  a 
powerful,  penetrating  stimulant,  and  has  been  em- 
ployed in  a  large  number  of  cases  with  gratifying 


PYORRHCEA  ALVEOLARIS.  507 

success.  It  is  cleanly,  but  the  odor  is  a  drawback. 
It  can  be  used  undiluted  in  which  case  the  skin  is 
smeared  with  vaseline  to  prevent  dessication,  or 
pure,  combined  w^ith  olive  oil  in  the  proportion  of 
turpentine  1  drachm  to  7  drachms  of  olive  oil,  and 
upward.     (Ck.) 

For  a  base  of  ointments,  lard  or  vaseline,  combined 
advantageously  v^ith  10  to  40  per  cent,  of  lanoline, 
is  most  frequently  employed.  If  a  plaster  is  desired, 
use  Unna's  paste. 

India  Rubber  Underwear: — Recommended  by 
Crocker  to  be  w'orn  continuously  for  twelve  hours  or 
more  and  changed  night  and  morning.  The  effect,  he 
claims,  is  excellent,  especially  if  the  skin  becomes 
moist  and  macerated. 


PUERPERAL  FEVER. 

See  Septicaemia  and  Puerperal  Metritis. 

PYORRHCEA  ALVEOLARIS. 

Carbolic  Acid: — The  persistent  application  of  the 
freely  crystals  will  cure  this  affection. 

Hydronapthol: — Gr.  xvj,  alcohol,  3j,  water,  |j ;  a 
teaspoonful  to  half  a  pint  of  water  may  be  used 
freely  with  good  effect  as  a  mouth  wash.     (Al.) 

Pyrozone: — 2  to  5  per  cent,  solution  in  ether,  has 
been  found  a  very  effective  stimulant  and  caustic  ap- 


508  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

plication,  especially  serviceable  in  checking  suppura- 
tion.    (F.) 

Menthol : — As  an  anodyne  and  antiseptic.    (F.) 


RABIES. 

Immediate  measures  for  the  elimination  of  the 
poison  from  the  wound  should  be  employed,  viz.: 

Suction: — The  patient  should  immediately  suck  the 
wound ;  if  he  is  unable  to  do  so  himself,  a  second 
person  may  do  so  for  him,  though  it  is  not  without 
danger,  owing  to  possible  abrasions  of  the  mouth. 
The  mouth  should  be  rinsed  immediately. 

Cauterization:— Stands  next  in  availability.  The 
Actual  Cautery  should  be  freely  applied ;  red  hot 
iron  poker,  or  any  iron  article.  The  Paquelin  or 
galvanic  cautery  should  be  used  if  convenient,  but 
the  chances  are  these  instruments  veill  seldom  be  ac- 
cessible. The  pain  of  the  actual  cautery  is  not  more 
severe  than  mineral  escharotics  and  it  should  always 
be  preferred,  but  in  its  absence  the  Nitrate  of  Silver 
crayon  thoroughly  applied  or  Caustic  Soda  may  be 
used.  It  is  claimed  that  the  former  is  especially 
effective.  Carbolic  Acid,  pure,  or  Corrosive  Subli- 
mate, 1—500  or  1000,  may  be  used  as  substitutes,  but 
only  when  the  cautery  is  not  available.     (Ty.) 

Excision  of  the  ^Vound: — Recommended  as  a  para- 
mount necessity  by  some  writers.  (Hy.)  As  it  is 
claimed  that  the  instrument  used  may  become  in- 
fected by  the  virus  from  the  ^vound,  caution  is  neces- 
sary. 

Pasteur's  Attenuated  Virus: — This  treatment  can 


RANULA.  509 

only  be  carried  out  at  a  Pasteur  institute,  one  of 
which  is  situated  in  New  York.  A  careful  examina- 
tion of  the  results  of  this  method  by  exact  and  con- 
scientious observers  show  it  to  be  an  efficient  agent 
in  saving  life. 

For  the  paroxysms ;  Chloroform  Inhalations;  sub- 
cutaneous injections  of  Morphia  in  full  doses ;  Curare, 
in  doses  of  j\  to  ^  grain,  or  Ethyl  Bromide  in  doses 
up  to  a  drachm,  both  subcutaneously.  Amyl  Nitrite 
inhalations  should  also  be  tried.     (B.) 


RANULA. 

Iodine: — A  few  drops  injected  into  the  sac,  usually 
effects  a  cure.     (H.) 

Chromic  Acid: — After  evacuation  and  washing  out 
of  cavity  the  saturated  solution  may  be  freely  ap- 
plied.   (Sm.) 

Nitrate  of  Silver: — The  crayon  after  removal  of  a 
portion  of  the  sac. 

Nitric  Acid: — Ma}^  be  employed  if  a  stronger  agent 
is  desired,  but  other  remedies  are  preferable.     (Bt.) 

Seton: — An  old  and  effective  method.     (HI.) 


RECTUM,  PROLAPSUS  OF  THE. 

In  recent  prolapsus  the  immediate  indication  is  re- 
placement of  the  bowel  and  relief  of  strangulation. 
Place  the  patient  on  the  left  side  with  the  pubes  well 
elevated,  the  shoulders  and  head  depressed,  or  in  the 
knee  and  elbow  position,  in  either  of  which  the  re- 


510  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

placement  of  the  bowel  is  assisted  by  gravitj'.  The 
fingers  of  the  operator  and  the  protruded  mass 
should  then  be  well  lubricated  and  stead3^  and  gentle 
pressure  exerted  on  the  bowel  in  the  direction  of  its 
narrow^ed  position.  This  procedure  will  generally 
succeed.  When  the  spasm  of  the  sphincter  is  so  great 
that  reduction  is  impossible  without  injury  to  the 
bowel,  and  gangrene  is  threatened,  the  patient 
should  be  etherized  and  the  sphincter  dilated  at  once, 
w^hen  the  prolapsed  bowel  can  be  restored.     (W.) 

In  children  non-operative  or  palliative  treatment 
is  generall}^  successful ;  the  child  should  never  be 
allowed  to  sit  and  strain  when  the  bowels  move,  but 
movements  should  be  passed  lying  upon  side  or 
standing,  one  buttock  being  drawn  aside  so  as  to 
tighten  the  relaxed  sphincter.  When  the  bowel  has 
protruded  it  should  be  douched  with  cold  water  and 
an  astringent  applied.     (All.) 

The  following  time-honored  astringent  remedies 
are  recommended : 

Alum,  one  of  the  most  useful  agents,  may  be  em- 
ployed in  the  strength  of  2  drachms  to  the  pint  of 
distilled  water  (Gt.),  or  in  solution  with  decoction  of 
oak  bark,  1  scruple  to  the  pint,  and  stronger  if  well 
borne.  (All.)  Tannic  Acid,  in  the  form  of  a  strong 
watery  solution;  Infus.  Matico,  Krameria,  Hama- 
melis  (All.),  Zinc  Sulphate,  gr.  ij-3J,  Tr.  Iron  gr.  xx- 
xxx-giv  (K.).  All  maybe  applied  to  the  protruded 
bowel  with  a  sponge  or  bit  of  soft  cotton,  and  in  the 
case  of  children  adhesive  plaster  should  be  applied  so 
as  to  draw  buttocks  together ;  in  adults  a  T  band- 
age should  be  employed. 

Ergot: — The  concentrated  fluid  extract  injected 
into  the  submucous  tissue  in  doses  of  5  to  7  grains, 


RECTUM,  PROLAPSUS  OF  THE.  511 

repeated  everv'  second  day  for  two  weeks,  is  a  pro- 
cedure ^vhich  was  recommended  on  high  author- 
ity (Agnew  and  Langenbeck),  but  is  deprecated  by 
Allingham  as  uncertain  and  liable  to  produce  ab- 
scess. 

Nitric  Acid:  —  Very  effectual  in  children,  recom- 
mended when  milder  measures  have  failed ;  the  pro- 
truded bowel  should  be  well  dried  and  the  acid  ap- 
plied, care  being  exercised  to  protect  the  anus  and 
skin  by  a  bland  ointment.  The  part  should  be  well 
oiled  and  returned  to  the  rectum,  ^Yhich,  by  some 
authorities,  is  recommended  to  be  packed  with  cot- 
ton. (All.)  Others  regard  adhesive  plasters  binding 
buttocks  together  as  sufficient.  The  limbs  also  had 
better  be  bound.    Anaesthesia  is  necessary. 

In  the  treatment  of  adults  nitric  acid  is  only  tem- 
porary in  its  effects;  in  elderlj^  persons  it  must  be 
used  with  caution  on  account  of  deep  sloughs  which 
ma^'  be  produced  in  debilitated  constitutions.     (All.) 

Linear  Cauterization: — In  adults  this  is  undoubt- 
edly the  best  means ;  the  patient  is  etherized  and 
placed  in  the  Sims  position ;  from  three  to  six  verti- 
cal stripes  should  then  be  made  on  the  mucous  mem- 
brane with  the  Paquelin  cautery  at  a  dull  red  heat. 
The  stripes  should  begin  three  inches  up  the  rectum 
and  end  at  the  junction  of  the  skin  and  mucous  mem- 
brane. 

Mr.  Allingham  in  severe  cases  burns  through  the 
sphincter  in  two  places  at  opposite  points  after  re- 
ducing the  bowel,  and  inserts  a  pledget  of  oiled  w^ool. 
He  applies  the  cautery  before  reducing  the  bowel. 
Van  Buren,  who  first  recommended  the  procedure, 
replaced  the  bowel  and  applied  the  cautery  through 
a  speculum. 


512  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

In  extensive  cases  of  long  standing  the  cautery 
may  be  applied  to  the  w^hole  circumference  of  the 
anus  so  as  to  produce  cicatricial  contraction.     (K.) 

Clamp  and  Cautery: — Constitute  the  most  radical 
treatment  of  this  condition,  and  may  be  resorted  to 
"when  all  other  means  have  failed ;  for  the  technique 
of  the  operation  see  works  on  surgery. 


RECTUM,  ULCER  OF. 

Rest  is  indicated  in  all  stages  of  treatment.  Rest 
in  bed  w^ith  fluid  diet  alone  will  cure  some  cases.  (K.) 

Local  treatment  varies,  and  will  require  changing 
from  time  to  time ;  it  is  long  and  tedious  and  will 
sorely  try  the  patient,  who  will  require  much  pa- 
tience. The  first  requirement  of  treatment  is  a  thor- 
ough cleansing  of  the  rectum ;  this  may  be  done  by 
copious  injections  of  sterilized  w^ater  or  Castile  soap 
and  water.     (Gt.) 

Irrigation  w^ith  some  antiseptic  solution  is  also 
employed  with  advantage  before  the  application  of 
local  remedial  agents.  Solutions  of  Boric  Acid;  Cor- 
Tosive  Sublimate,  1-5000-10,000;  Carbolic  Acid, 
1—100,  may  be  used  for  this  purpose. 

Ointments  are  generally  to  be  preferred  as  superior 
to  suppositories.  The  rectal  ointment  applicator  is 
necessary  for  their  administration. 

The  following  are  recommended  : 


M. 


Bismuth.  Subnitratis, 

3ij- 

Hydrarg.  Chloridi  Mitis, 

3ij- 

Morph.  Acetatis, 

gr-  ij 

Glycerini, 

3U. 

Vaselini, 

n 

RECTUM,   ULCER  OF.  513 

This  is  very  sedative  and  soothing. 

^.    lodoformi,  gr.  xx. 

Cocairiie,  gr.  xviij. 

Lanolini,  ^^ss. 

M.  (All.) 

Allays  irritation  and  pain. 

Hydrastis: — Useful  in  the  proportion  of  about  1 
drachm  of  the  fluid  extract  to  1  ounce  of  vaseline ; 
Iodoform  may  be  added  with  advantage. 

Belladonna,  Opium  and  Stramonium  in  the  form 
of  ointments,  combined  with  other  remedies,  form 
useful  adjuvants  for  the  relief  of  pain  and  spasm  of 
the  muscle.     (Pt.) 

Balsam  Peru : — A  mixture  composed  of  half  an 
ounce  of  the  balsam,  glycerine  1  ounce,  water  4 
ounces,  will  prove  healing  and  soothing.  The  pure 
balsam  will  act  well  as  a  stimulant  applied  over  the 
surface  of  the  ulcer.  (Gt.)  Strong  preparations  of 
balsam  of  Peru  wnll  sometimes  cause  great  irritation 
followed,  however,  b\'  beneficial  results. 

Nitrate  of  Silver: — A  solution  of  gr.  v— x-^j  brushed 
over  surface  of  ulcer  through  the  speculum  is  bene- 
ficial. (W.  C.)  Copious  irrigation  with  a  solution 
of  gr.  XX— xl-Oj  is  effective  in  dysenteric  ulceration. 
(All.)  When  the  ulceration  is  high,  the  amount 
of  fluid  injected  should  be  large;  3  pints  may  be 
thrown  into  the  upper  part  of  the  rectum,  sigmoid 
flexure,  and  lower  part  of  the  colon.  The  long  flexi- 
ble rubber  tube  should  be  employed,  and  the  injec- 
tion made  slowly  with  the  patient  on  the  side.     (K.) 

Cocaine: — In  the  form  of  suppositories  or  a  solu- 
tion, gr.  x-xv-sj,  is  often  of  great  service  in  allaying 
pain  and  irritation. 
34 


514  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Glycerine : — Injection  of  4  drachms  as  a  lubricant 
and  evacuant.     (F.) 

Nitric  Acid  : — The  fuming  acid  has  been  highly  rec- 
ommended as  a  cauterant.     (Gt.) 

Dusting  powders  introduced  by  an  insufflator 
through  the  speculum  are  very  useful ;  the  best  are 
the  following:  Acetanilid,  Alum,  Bismuth  Subni- 
trate,  and  Subiodide,  Boric  Acid,  Calendulated  Boric 
Acid,  Iodoform,'  Lead  Acetate,  and  Zinc  Stearate. 
These  remedies  may  be  applied  in  the  form  of  oint- 
ments with  the  applictator  after  irrigation,  or  in  the 
form  of  suppositories,  though  the  latter  is  the  least 
desirable  method  of  applying  remedies  to  the  rectum 
as  their  introduction  is  often  attended  wnth  pain. 
They  are  often,  how^ever,  used  for  the  sake  of  conve- 
nience. 

Operative  procedures  are  frequently  necessary,  viz.: 

Forcible  Dilation  of  the  Sphincter  follow^ed  by  two 
or  three  applications  of  nitrate  of  silver  if  the  cause 
is  traumatic;  Curettage,  of  benefit,  especially  in 
tuberculous  ulcerations;  Linear  Incision  through  the 
base  of  the  ulcer;  Excision;  Division  of  the  base  of 
the  ulcer,  including  the  sphincter;  Elliptical  Inci- 
sions when  the  ulcer  is  not  too  large  and  does  not 
extend  through  the  mucous  membrane.  The  edges 
should  be  brought  together  with  catgut  sutures. 
(Gt.) 


RHEUMATISM. 

ACUTE  ARTICULAR  RHEUMATISM. 

Local  measures  play  a  secondary  part  in  the  treat- 
ment of  the  disease.    The  joints,  both  those  involved 


RHEUMATISM.  515 

and  those  not,  should  be  washed  with  warm  water 
and  soap,  and  enveloped  in  absorbent  cotton  or 
flannel,  held  in  position  by  flannel  bandages.  These 
should  be  changed  every  two  or  three  daj-^s,  and  the 
surface  carefully  cleansed  with  warm  water.  The 
entire  surface  of  the  body  should  also  be  carefiilly 
bathed  at  frequent  intervals  so  that  the  skin  is  kept 
in  good  condition.  Blankets,  changed  at  suitable 
intervals,  should  be  used  for  bed  clothing,  and  the 
swollen  limbs  supported  by  pillows  covered  with 
flannel.     (Gn.) 

Salicylates: — When  not  tolerated  by  the  stomach, 
administration  by  the  rectum  is  often  attended  with 
satisfactory  results.  First  wash  out  the  bov^el  with 
warm  water,  then,  after  an  interval,  inject  from  20 
to  40  grains  of  sodium  salicylate  in  solution.  This 
may  be  done  every  six  hours.  (Ty.)  An  ointment 
for  application  to  the  swollen  joints  is  as  foUow^s: 

p.    Acid.  Salicylici, 

Lanolini, 

Ol.  Terebinthinse, 

Adipis,  aa  3iij- 

M.  (An.) 

The  following  have  also  been  used  for  application 
to  the  joints : 

9;.    Liq.  Opii  Sedativi,  gj. 

Potass.  Bicarbonatis,  5^^. 

Glycerini,  •  ^ij. 

Aq.  Bullientis,  gix. 

Sig.     Soak  a  piece  of  flannel  in  the  above  solution  hot  and 
wrap  around  painful  joint.     (Os. ) 

Fuller's  lotion : 

9;.    Sodii  Carbonatis,  3^]- 

Tr.  Opii,  ,^j. 

Glycerini,  gij. 

Aquae,  ,lix. 
Sig.     Hot  cloths  saturated  with  this  lotion  may  be  applied  to 

the  swollen  joints.  (Os.) 


516  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Paquelin  Cautery: — Applied  with  a  light  touch 
above  and  below  the  joint  is  better  than  bhsters, 
and  acts  well  for  the  relief  of  pain. 

Fixation  of  Parts : — This  measure  is  of  great  ser- 
vice; use  splints  for  this  purpose.     (Os.) 

Cold  Baths: — For  hyperpyrexia  the  treatment 
must  be  energetic  and  prompt,  extraordinary'  high 
temperature  being  inevitably  fatal  in  a  few  hours. 
For  this  condition  the  one  treatment  is  the  applica- 
tion of  cold.  As  soon  as  a  temperature  exceeds  105° 
the  bath  should  be  employed.  If  deUrium  or  uncon- 
sciousness is  associated  with  the  high  fever  the  baths 
are  all  the  more  indicated.  If  time  permits  the  tem- 
perature of  the  baths  may  be  gradually  made  cold, 
commencing  with  a  temperature  of  70°,  ice  may  be 
added  if  necessary. 

Ice  Water  Effusion: — Rubbing  the  head  and  body 
with  ice  may  be  substituted  for  the  bath,  though  the 
latter  is  preferable.  Numerous  cases  are  reported 
with  temperatures  ranging  from  107°  to  109^  when 
this  treatment  was  successful.    (Ty.) 

CHRONIC  ARTICULAR  RHEUMATISM. 

Amber  Oil: — As  a  rubefacient  is  useful  combinated 
as  follows : 

p.    Ol.  Ambrae  Griseae,  *        3vj. 
Ol.  Rosmarini, 

.  Ol.  Bergamottae,  aa  3j- 

Ol.  Terebinthinae,  5J- 

Ol.  Lini,  ad  ^iv. 

M.  (F.) 

\Vintergreen  Oil: — Equal  parts,  mixed  with  olive 
oil,  appUed  to  joints  which  are  wrapped  in  cotton 
batting,  is  used  for  relieving  pain.    (F.) 


RHEUMATISM.  517 

Massage: — One  of  the  most  important  measures 
for  the  relief  of  stiffness,  pain,  and  contractures  re- 
sulting from  rheumatism  as  well  as  the  disease  in  the 
chronic  state.  It  should  be  persevered  in  diligently 
and  patiently.  To  remove  nodosities  the  following 
plan  has  been  recommended :  Apply  emollient  poul- 
tices for  one  or  two  da3'S  continuously,  then  ener- 
getic kneading  under  anaesthesia  to  crush  them ;  fol- 
low^  this  with  daily  massage.     (Sj.) 

Sulphur  Fumigation: — Subjecting  the  joint  to  the 
fiimes  of  sulphur  has  proved  useful.  (F.)  Somewhat 
on  the  same  principle  is  the  old-fashioned  remedy  of 
putting  flowers  of  sulphur  in  the  stockings,  which  is 
not  without  efiect.(Rd.) 

Iodine: — May  be  painted  over  joint  with  advan- 
tage.    (Al.) 

Potass.  Iodide: — 90  grains,  dissolved  in  water  and 
rubbed  up  with  an  ounce  of  lanoline  is  often  very 
beneficial;  it  should  be  well  rubbed  in  over  the 
affected  part,     (M.  H.) 

lodoforni: — The  following  is  claimed  to  be  superior 
to  iodide  of  potassium  applications:  Iodoform  1 
part,  collodion  or  flexible  collodion  8  to  15  parts, 
paint  freely  on  involved  joints.  Make  the  second  ap- 
plication over  the  first,  only  removing  loosened 
scales  of  collodion.     (Jac. ) 

Fir  \A^ool: — For  enveloping  the  joint,  used  espe- 
cially b\-  the  Germans,  but  does  not  appear  to 
possess  any  advantage  over  ordinary  cotton  wool 
or  flannel.     (F.) 

Zinc  Sulpho-Ichthyolate: — Sometimes  proves  use- 
ful in  the  form  of  a  soap  liniment,  or  ointment,  in  the 
proportion  of  45  grains  to  the  ounce.     (F.) 

Ichthyol: — A    25    to    50    per    cent,    ointment    or 


518  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

glycerite  continuously  applied  to  joint  is  often  effect- 
ive.    (M.  H.) 

Thiol: — Has  been  used  in  the  following  combina- 
tion, thiol  and  vaseline,  each  1  drachm,  lanoline,  1 
ounce.    (Al.) 

Guaiacol : — Equal  parts,  with  glycerine  painted 
over  painful  areas  and  covered  Avith  a  dry  imperme- 
able dressing  will  sometimes  afford  relief.     (F.) 

Tr.  Opium: — The  following  is  endorsed  by  Hughes, 
of  London: 

^.    Tr.  Opii,  5j, 

Potass.  Carbonatis,  ^j- 

Aq.  Bullientis,  Oj. 

M. 

Sig.     Apply  with  a  soft  cloth  and  cover  with  dry  cotton.  (Ga.) 

Conium: — An  ointment  of  the  bruised  leaves,  or  the 
following,  for  the  relief  of  chronic  rheumatism  or 
gouty  synovitis : 

5fc.    Ext.  Conii,  5j. 

Cocain.  Hydrochlatis,  gr.  v. 

Atrop.  Sulphatis,  gr.  j. 

Veratrinae,  gr.  xx. 

Ung.  Aq.  Rosse,  5j. 
M.  (Sm.) 

Superheated  Steam : — A  hot  air  cylinder  con- 
structed for  the  purpose  is  used.  The  hand  or  arm  is 
enclosed  in  asbestos  and  inserted  into  the  cjdinder. 
A  thermometer  is  inserted  through  a  small  hole  in 
the  tube;  care  must  be  exercised  that  it  does  not 
come  in  contact  with  the  limb.  The  initial  tempera- 
ture does  not  usually  exceed  70°  C,  and  is  increased 
according  to  the  endurance  of  the  patient;  most 
patients  are  able  to  endure  a  temperature  of  120°  C. 


RHEUMATISM.  519 

without  much  discomfort.  Profuse  perspiration  al- 
wa^'S  occurs  and  the  air  in  the  cyHnder  is  soon  sat- 
urated -with  moisture.  It  is  believed  that  this  must 
be  the  condition  in  all  forms  of  apparatus,  on  ac- 
count of  the  ordinary  laws  of  osmosis.  Of  course  the 
skin  does  not  attain  anything  like  the  temperature 
of  the  air  in  the  cylinder,  and  it  is  probably  protected 
by  the  la3^er  of  gas  formed  from  the  evaporated  per- 
spiration. The  healing  factors  seem  to  be  the  per- 
spiration and  the  increased  activity  of  the  circula- 
tion. This  diaphoretic  action  is  not  limited  to  the 
parts  treated,  but  it  may  affect  the  Avhole  bodj^  The 
usual  immediate  results  are  relief  of  the  pain,  then 
increased  activity  of  movement  and  loss  of  the  feel- 
ing of  weakness.     (M.  M.  W.,  5,  17,  98.) 

Liniments: — Chloroform,     Aconite,      Belladonna, 
Turpentine  ;  also  the  following  combinations : 
9f.  Ol.  Gaultherise, 

01.  Olivse, 

Lin.  Saponis, 

Tr.  Aconiti, 

Tr.  Opii,  '  aa  3ij- 

M. 

9;.    Ol.  Cajuputi, 

Tr.  Opii,  aa  3ij- 

01.  Terebinthinse,  Jiv. 


M. 


Ivin.  Ammoniae,  ,^j. 


9;.    Lin.  Aconiti  (B.  P.), 

Lin.  Belladonnai,  aa  5ij- 

Glyceringe,  ad  gij. 

M. 

ft.    Chloroformi, 
Tr.  Aconiti  rad., 

Ol.  Terebinthinse,  aa  §ss. 

Ol.  Sassafras,  M.  v. 

Lin.  Sapo.  Camphorat.,  S^J^S- 

(Sn.) 


520  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Electricity: — In  the  form  of  faradism,  is  often  of 
positive  benefit.     (Bt.) 

Pine  Needle  Baths: — A  preparation  sold  in  the 
markets  ready  for  use,  or  the  oil  in  the  proportion  of 
1  minim  to  a  gallon  of  water,  forms  an  agreeable 
and  useful  bath.     (F.) 

Turpentine  Baths: — 5  to  10  ounces  to  a  bath  tub 
full  of  water. 

Alkaline  Baths: — May  be  used  when  the  natural 
water  of  a  mineral  spring  are  not  available. 

Hot  Air  Baths: — This  method  is  often  productive 
of  good  results,  but  is  contra-indicated  w^hen  there 
are  organic  cardiopathies.  (F.)  The  limb  is  encased 
in  a  specialh"  prepared  cylinder  containing  air  at  a 
temperature  of  150°  F.  and  gradually  increased  to 
240°  F.  The  application  is  continued  for  forty  to 
forty-five  minutes.     (Sj.) 

Arsenical  Baths: — Prepared  by  dissolving  from  15 
to  45  grains  of  sodium  arsenite  and  3  ounces  of 
sodium  carbonate  in  a  bath  tub  full  of  \vater.  They 
are  useful- in  rheumatic  arthritis,  and  may  be  admin- 
istered daily  or  every  other  day.  Thirt^^  baths,  it  is 
said,  will  relieve  articular  pain  and  stiffness.  Gastric 
disorders  may  appear  at  the  beginning,  and  the  pain 
at  first  may  be  aggravated,  but  on  discontinuing  the 
sodium  carbonate  these  symptoms  disappear.    (F.) 

Mud  Baths; — Those  of  Schwalbach,  Marienbad, 
St.  Armand,  Franzenbad  are  all  useful.  When  there 
is  cardiac  disease  the  temperature  of  the  bath  must 
not  be  too  high  or  the  bath  too  long. 

Mineral  Spring  Baths: — A  great  number  are  recom- 
mended for  the  treatment  of  the  rheumatic  diathesis 
and  for  chronic  forms  of  the  disease.  A  few  of  the 
better  known  are  Richfield,  Hot  Sulphur  in  Virginia, 


RHEUMATISM.  521 

Mt.  Clemens,  and  Glenwood.  Great  benefit  is  often 
derived  from  a  course  of  treatment  at  one  of  these 
resorts. 

Turkish,  \Varm  Sea  ^Vate^  and  Sulphur  Baths 
will  prove  useful  in  some  cases. 

MUSC  ULAR  RHEUM  A  TISM. 

Heat: — This  is  very  effective  in  many  forms,  viz.: 
Hot  Water  Bag  or  Bottle,  Ironing  the  part  with  hot 
flat  iron,  wdiile  protecting  the  skin  with  a  piece  of 
flannel;  Hot  Douche  ;  Hot  Fomentations  of  Flaxseed 
Meal  and  Laudanum ;  Flannels  w^rung  out  in  hot 
water'and  covered  with  oiled  silk  to  retain  heat,  and 
Mustard  Fomentations. 

Cold: — Sometimes  useftil,  though  heat  is  generally 
more  agreeable.  A  Methyl-Chloride  Spray  is  said  to 
cure  in  lumbago  and  pleurodynia,  according  to 
Bartholow%  almost  immediately.  Ether  is  also  em- 
ployed for  the  same  purpose,  the  relief  being  some- 
times permanent.     (R.) 

Salicylic  Acid: — A  2  per  cent,  ointment  freely 
rubbed  in  the  skin  has  given  good  results  in  subacute 
and  obstinate  cases.     (An.) 

Ether  or  Chloroform: — A  few  drops  subcutaneously 
in  old  cases  are  very  beneficial.     (B.) 

Massage: — One  of  the  most  effective  agents;  the 
application  of  a  stimulating  liniment  may  be  com- 
bined with  advantage. 

Liniments  : — The  various  anodyne  and  stimulating 
liniments  are  all  used,  those  most  useful  being  tur- 
pentine, chloroform,  and  belladonna.     (L.  T.) 

The  following  is  highly  praised  for  muscular  rheu- 
matism, lumbago,  and  sciatica: 


522  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

1*.    Sodii  Salicylatis,  J  ss. 

Ol.  Cajuputi.,  ^ss. 

01.  Eucalypti,  M.  xv. 

Lin.  Saponis,  ^ss. 

Spts.  Rectificati,  ^vj. 
M.  (T.,97.) 

Also, 

9;.    Lin.  Chloroformi,  ^iij, 

Tr.  lodi, 

Tr.  Aconiti  Rad.,  aa  gij. 

Tr.  Opii,  |ss. 

M.  (Sn.) 

Iodine: — The  tincture  painted  on  the  affected  joint 
until  the  skin  becomes  tender,  is  sometimes  of  ser- 
vice.    (R.) 

Capsicum: — Steep  a  handful  of  crushed  pods  in  half 
a  pint  of  hot  water  for  twenty-four  to  thirty-six 
hours,  then  strain  and  bottle  for  use.  Soak  a  piece 
of  lint  in  this  liquid  and  apply  to  the  affected  part, 
which  should  be  covered  ^vith  oiled  silk.  It  does  not 
vesicate,  and  will  relieve  in  a  most  striking  Tvay.  (R.) 

Anodyne  Colloid.:  —  Often  affords  quick  relief;  if 
pain  continues  a  piece  of  absorbent  cotton,  wet  w^ith 
Avarm  water,  should  be  placed  over  the  film.  (F.) 
See  Neuralgia. 

Morphine  : — Hypodermically  over  the  seat  of  pain 
will  often  cut  short  an  attack  if  seen  early.     (An.) 

Belladonna: — The  plaster  or  ointment  the  latter 
preferable.     (Al.) 

The  following  also  is  used : 

9.    Ung.  Belladonnse, 

Ung.  lodi.  Comp.,  aa  ,^ss. 

Sig.     Rub  in  twice  a  day  and  apply  heat.  (Sn. ) 

Theine  : — Hypodermicallj^  in  doses  of  i  grain  has 
been  used  with  success.     (F.) 


RHINITIS.  523 

Osmic  Acid  : — Hj^podermically  in  closes  of  8  to  10 
drops  of  a  1  per  cent,  solution,  deep  in  the  muscle. 
(F.) 

Strapping: — This  will  be  found  of  service  in  pleuro- 
dynia ;  the  involved  muscles  may  be  treated  by  com- 
plete rest  by  strapping  the  side  as  in  fracture  of  the 
rib.     (Ty.) 

Aquapuncture : — Has  been  successfully  employed. 

Braunscheidtismus: — An  old  remedy,  will  some- 
times afford  instant  relief.     (B.) 

Paquelin  Cautery: — Applied  gently  and  rapidly 
over  large  surfaces,  is  said  to  "act  like  magic." 
(L.  T.)  The  practical  application  of  such  a  remedy 
Avould  seem  doubtful. 

Hydrotherapy:  —  Warm  or  cold  pack,  Turkish 
baths,  hot  air  baths,  sulphur  and  other  mineral 
springs  as  advised  in  chronic  rheumatism. 

Electricity -.—Either  in  the  form  of  galvanism  or 
faradism,  is  useful  in  chronic  cases. 


RHINITIS. 

ACUTE  RHINITIS. 

Menthol: — One  of  the  most  frequently  employed 
remedies  for  this  condition.  It  is  given  first  import- 
ance by  Lennox  Browne,  being  preferred  by  him  to 
cocaine.  He  advises  its  administration  by  any  one 
of  the  following  methods : 

(1)  A  10  per  cent,  solution  in  almond  oil,  in  liquid 
vaseline,  or  in  one  of  the  many  odorless  paraffine 
compounds,  to  be  sprayed  into  the  nose  or  about  the 
room. 


524         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

(2)  By  placing  1  to  2  drachms  of  the  oily  solution 
in  a  Lee's  steam  draft  inhaler  or  a  bronchitis  kettle. 

(3)  To  carry  a  Cushman's  pocket  menthol  inhaler. 
The  vapor  of  the  following  combination,  inhaled 

from  a  wide-mouthed  bottle  or  pocket  inhaler,  will 
add  to  the  comfort  of  the  patient :  Oil  of  menthol,  1 
drachm,  with  carbonate  of  ammonia,  half  an  ounce ; 
or  oil  of  menthol,  1  drachm,  with  2  drachms  each 
of  camphor  and  carbonate  of  ammonia. 

Menthol  Chloroform: — In  the  strength  of  10  per 
cent.,  for  the  purpose  of  aborting.  Place  a  few- 
drops  on  a  handkerchief,  and  take  about  five  deep 
inhalations.  The  secretions  are  at  first  increased, 
but  afterwards  diminished.     (T.,  97.) 

Carbolic  Acid: — A  popular  German  remedy,  called 
Hager's,  is  as  follows : 

9;.    Acid.  Carbolici,  3j. 

Alcohol .  Fort . ,  3  ii j . 

Aq.  Ammoniae  Fort.,  3J. 

Aq.  Destill.,  gij. 
M. 

Sig.     To  be  used   as  an  inhalation   from   an  open-mouthed 
bottle. 

Half  an  ounce  of  a  1-20  solution  to  a  pint  of 
water  is  useful  in  washing  out  the  nose,     (T.,  96.) 

Steam   Inhalations  :  — Always  grateful ;  following 
may  be  added  to  boiling  water  in  about  the  propor- 
tion of  a  teaspoonful  of  the  mixture  to  half  a  pint : 
9;.    Tr.  Lupulini,  .3J. 

Tr.  Benzoini  Comp  ,  '^vij. 

M. 

Or, 

9.    Camphorse,  gss. 

Ol.  Eucalypti,  M.x. 

Terebinthinge,  M.xij. 

Alcoholis,  ad  Jij. 
M.  (Bn.) 


RHINITIS.  525 

Camphor: — An  old  and  well-tried  remedy;  the 
spirits  may  be  inhaled  from  a  bottle,  or  when  added 
to  boiling  water  in  some  of  the  combinations  as 
mentioned. 

Chloroform: — 1  drachm  may  be  added  to  the  ben- 
zoin inhalation  above  mentioned,  to  increase  its  sed- 
ative action.     (Al.) 

The  following  are  to  be  employed  with  the  atom- 
izer: 

Calendula: — Very  useful  after  operations  about  the 
nose,  viz.: 

^.    Succi  Calendulge,  ^iss. 

Liq.  Alboleni,  ^ij. 

M.  (Tn.) 

Cocaine: — Is  used  for  controlling  the  venous  tur- 
gescence.  It  is  claimed  that  it  has  more  than  a  palli- 
ative action.  Applied  every  three  or  four  hours  it 
may  arrest  or  control  the  attack ;  the  following  for- 
mulae are  recommended : 


Ijt.    Cocain.  Hydrochloratis, 

gr.  XX. 

Morphinse, 

gr.  ii. 

Aquae, 

3J- 

Ft.  Sol.  et  adde, 

Cosniolin.  Liquid., 
M. 

Sj- 

Sig.     Apply  with  a  Burgess  atomizer. 

(B 

J^.    Cocain.  Hydrochloratis, 

gr.  V. 

Ol.  Eucalypti, 

M.XX-3J 

Vaselini  vel  Lanolini, 

ad^j. 

Bos.) 


M. 

Mackenzie   recommended    the   following   effective 
combination : 

T^.    Mentholi,  gr.  v. 

Pinoli,  M.v. 

Benzoinoli,  ^j. 
M. 


526  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Snuff  Powders:— Are  very  often  used,  but  are  not 
as  effective  as  sprays.  Moreover,  to  some  very  sen- 
sitive mucous  membranes  the  effect  of  a  powder  is 
not  as  agreeable  as  a  spraJ^ 

The  follov^nng  are  recommended  : 

T^.    Morph.  Hydrochloratis,  gr.  ij. 

Pulv.  Acacise,  3^j- 

Bismuth.  Subnitratis,  5vj- 

M. 

This  is  knoAvn  as  "  Ferrier's  Snuff."  In  using  prep- 
arations of  morphine  it  must  be  remembered  that 
the  drug  can  readily  be  absorbed  by  the  nasal 
mucous  membrane. 


(Bn.) 


^. 

Antipyrini, 

gr.  xij. 

Camphorae, 

gr.  X. 

Sac.  Laclis, 

ad  5iij. 

M. 

?t. 

Cocaiti.  Hydrochloratis, 

gr.  iss. 

Mentholi, 

gr.  iiss. 

Acid.  Salicylici, 

gr.  viij 

Acid.  Borici, 

.^j- 

Amyli, 

3iss. 

M. 

Sig 

.     A  pinch  every  two  hours  after 

blowing  the  nose. 

?fe. 

Cocain.  Hydrochloratis, 

gr.  |. 

Bismuth.  Salicylatis, 

gss. 

Pulv.  Camphorae, 

3J-     ,. 

(T.,96.) 

Eucalyptus: — Infusion  of  the  leaves  for  w^ashing 
out  nostrils,  or  the  oil,  a  few^  drops  on  cotton  inserted 
into  the  nostrils  for  the  relief  of  the  sensation  of 
fullness. 

Chamomile: — Infiisions  with  a  little  alum  intro- 
duced into  the  nostrils,  is  very'  useful  for  the  coryza 
of  infants.     (T.,  97.) 


RHINITIS.  527 

Boric  Acid: — An  ointment  made  with  vaseline  in 
the  strength  of  10  per  cent,  for  appHcation  to  the 
nose  when  there  is  irritation.     (T.,  96.) 

Lemon  Juice: — The  hands  are  rubbed  with  some 
drops  of  the  Hquid,  and  are  then  held  in  front  of  the 
mouth  or  nose,  while  deep  inspirations  are  taken. 
The  sneezing  is  said  to  cease  after  the  first  few  in- 
halations.    (T.,  96.) 

Hot  Foot  Bath: — At  bed  time,  in  conjunction  with 
copious  draughts  of  cold  Avater  during  and  after 
bath  to  induce  free  perspiration,  when  promptly  car- 
ried out  will  often  avert  a  cold  in  its  incipient  stages. 
(Rd.) 

To  Diminish  Excessive  Sensitiveness  to  Cold: — 1. 
Free  exposure  to  the  open  air  daily.  2.  The  morn- 
ing cold  bath.  Cold  sponging  over  the  entire  sur- 
face of  the  body,  the  plunge  bath,  or  the  shower 
bath  are  invaluable  methods  of  protecting  the  body 
against  injurv^  from  exposure  to  changes  of  tempera- 
ture. Taken  regularly  in  the  morning,  the  cold  bath 
inures  the  surface  of  the  body  to  a  greater  degree  of 
cold  than  it  will  probabh^  encounter  during  the  day ; 
at  the  same  time  it  promotes  a  vigorous  capillary 
circulation,  which  is  essential  to  the  harmonious 
and  healthy  working  of  the  system.  3.  Breathing 
through  the  nostrils.  Infants  should  be  taught  to 
breathe  through  the  nostrils,  especially  during  sleep. 
(Rd.) 

SIMPLE  CHRONIC  RHINITIS. 

Cleanliness  is  the  first  essential ;  the  nasal  cavities 
should  be  thoroughly  and  carefully  cleansed  of  all 
mucous  accumulations  before  local  remedial  agents 


528  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

are  applied.  The  following  are  effective  for  this  pur- 
pose, using  the  compessed  air  apparatus,  the  nasal 
atomizer  being  employed  by  the  patient  at  home: 
Sailer's  Antiseptic  Tablets;  Dobell's  Solution;  and 
Benzoic  Acid,  gr.  x,  with  2  drachms  each  of  Chlor- 
ide of  Sodium  and  Bicarbonate  of  Soda;  half  of  this 
powder  being  added  to  a  glass  of  water;  or  Borax, 
2  grains  to  the  ounce  of  water,  together  with  a  little 
glycerine,  may  be  used.     (Bp.) 

After  the  nasal  cavities  have  been  cleansed  altera- 
tive or  astringent  applications  should  be  employed, 
according  to  the  indications ;  these,  generally  speak- 
ing, are  of  two  varieties,  liquids,  including  oleagi- 
nous preparations  and  solutions,  and  insufflating 
powders ;  the  former  should  be  applied  in  the  form  of 
a  spray  by  means  of  the  compressed  air  apparatus. 

Liquid  Applications. 

The  petroleum  oils  form  the  menstrum  for  the 
oleaginous  compounds,  viz.:  Albolene,  Benzoinol, 
Cosmoline,  liquid  Vaseline,  etc.  In  these  some  me- 
dicinal agent  is  dissolved,  usually  in  proportion  of  1 
to  10  per  cent. 

Camphor- Menthol: — 10  per  cent,  in  lanolin  is  a 
serviceable  remedy;  it  relieves  stenosis  and  conges- 
tion, and  prepares  the  body  for  the  two  succeeding 
formulae : 

Calendula:  —  4  parts,  hamamelis  8  parts,  pinus 
strotus  8  parts,  lanolin  80  parts.     (Bp.) 

Hydrastis; — 1  drachm  of  tincture  to  the  ounce  of 
water  is  useful  when  there  is  a  tenacious,  stVingy 
mucous  dropping  from  the  posterior  nares. 

Menthol  Crystals: — Gr.  v— x,  albolene,  .^j.     (Ty.) 


RHINITIS. 


529 


Terebene :  —  Gtt.  x,  albolene,  5J,  applied  twice 
daih%  is  one  of  the  most  effective  applications.    (Bp.) 

Cocaine: — A  4  per  cent,  solution  will  relieve  when 
there  is  considerable  temporary-  swelling  of  the 
mucous  membrane.     (Iv.) 

The  following  solutions  are  also  serviceable  for 
application  with  the  atomizer : 

9= 


M. 

Or, 


M. 


Ext.  Pini  Canaden., 

Glycerini, 

Aquse, 


Thymoli, 
Eucalyptoli, 
Menthol  i, 
01.  Cubebae, 
Ol.  Rosse, 
Benzoinoli, 


Or, 

^.    Thymoli, 

Alcoholi, 

Glycerini, 

Aquae, 
M. 

Or, 

p.    Acid.  Carbolici, 


gtt.   XX. 


gr.  X. 
gr.  XX. 
gr.  XXX. 

gr.  xl. 
q.  s. 
5iv. 


gr.  ss-v. 

3SS. 

3iss. 


(Qy.) 


(F.) 


M. 


Aquae, 


gr.  i]-v. 


(Al.) 


Insufflating  Powders. 


Aristol: — Alone,  or  in  combination  wath  Boric  or 
Tannic  Acid,  forms  a  ver^'  astringent  powder. 

Cerium  Oxalate: — 20  grains  to  the  ounce  of  acacia, 
for  catarrh  in  children, 
35 


530         DIGEST    OF   EXTERNAL  THERAPEUTICS 

Europhen : — For  catarrh  of  children,  and  for  reduc- 
ing hypersecretion  following  surgical  operations. 

Salicylic  Acid: — Mixed  with  some  indifferent  me- 
dium in  equal  proportions. 

Potass.  Sozoiodol: — Equal  parts  with  talc,  or  in 
proportion  of  1  to  2,  is  highly  commended. 

Sodium  Sozoiodol: — In  the  proportion  of  1  to  2 
with  talc,  especially  w^hen  discharge  is  muco-puru- 
lent.    (Al.) 

Gallic  Acid: — 4  grains,  with  acacia,  2  grains,  after 
cleansing  with  a  solution  of  bicarbonate  of  soda,  one 
of  the  best  applications.    ( Iv. ) 

Tannic  Acid: — 2  parts.  Iodoform,  1  part,  carefiilly 
triturated.     (F.) 

Cauterization: — When  engorgement  of  the  turbi- 
nated bodies  produces  swelling  of  these  structures 
and  consequent  constriction  of  the  nasal  passages, 
the  cautery  is  indicated.  The  galvano-cauter3'  should 
be  used  touching  the  sensitive  areas  as  practiced  in 
hay  fever.     (Ing.) 

In  absence  of  the  galvano-cautery,  mineral  cauter- 
ants  may  be  used,  as  mentioned  for  the  treatment  of 
hypertrophic  rhinitis.     (Bp.) 

Ethyl  Chloride : — 5  to  20  drops  on  a  handkerchief, 
inhaled,  has  good  effect.     (B.) 

Bougies  are  of  service ;  the}--  act  in  two  ways, 
namely,  hj  retaining  the  medicinal  agent  in  contact 
longer,  and  by  exerting  pressure;  a  small  piece  of 
cotton  should  be  placed  in  the  nostrils  to  prevent 
flow  of  mucus.     (Al.) 

Sea  bathing  and  sea  water  are  often  ver3'  bene- 
ficial.    (Iv.) 


RHINITIS.  531 

ATROPHIC  RHINITIS. 

Thorough  cleansing  is  the  first  requirement.  This 
is  best  accomplished  bv  detergent  alkaline  spra^-s, 
as  Dobell's  Solution,  Seiler's  Antiseptic  Tablets, 
solutions  of  Boric  Acid,  or  Borax.  Crusts  not  re- 
moved bj'  these  agents  may  be  brought  away  by 
means  of  a  probe  wrapped  in  cotton  and  dipped  in 
A-aseline. 

Hydrogen  Peroxide: — When  the  crusts  of  inspis- 
sated mucus  are  difficult  to  dislodge,  they  may  be 
softened  by  pledgets  of  lint  soaked  in  the  peroxide 
and  inserted  into  the  nostrils.     (Bl.) 

Formalin: — After  removing  crusts  wath  a  wealc 
alkaline  solution  apply  cocaine,  and  then  wash  out 
thenares  with  the  following  douche,  which  will  cause 
the  crusts  to  diminish  and  the  odor  to  cease : 

|k.    Formalini,  gtt.  v-x. 

Aquae,  Jviij. 

M.  (L.,  4,  98.) 

Galvano-Cautery  Electrode: — Used  for  the  re- 
moval of  the  crusts.  The  electrode  is  introduced 
cold,  put  in  contact  with  the  crusts,  which,  when  the 
current  is  turned  on,  adhere  with  great  tenacity  to 
the  heated  electrode  and  are  then  removed  with  ease. 
(Bn.) 

After  cleansing,  the  mucous  membrane  is  ready  for 
the  application  of  some  alterative  or  astringent 
agent,  which  will  vary  in  strength  according  to  the 
sensitiveness  of  the  parts. 

The  following  cleansing  deodorant,  antiseptic  and 
alterative  remedies  are  for  application  by  the  atom- 
izer or  compressed  air  spray  apparatus. 

Thymol: — Is  a  useful  deodorizer  and  cleanser,  but 


532  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

does  not  have  any  great  influence  on  the  course  of 
the  disease.    The  following  is  grateful : 

9;.    Tliymoli,  gr.  x. 

Eucalyptoli,  ■  gr.  xx. 

Mentholi,  gr.  xxx. 

Ol.  Cubebae,  gr.  xl. 

Ol.  Rosse,  q.  s. 

Benzoinoli,  giv. 
M. 

The  solution  may  be  used  stronger  or  weaker  as 
the  condition  requires.  A  solution  stronger  than  5 
per  cent,  is  seldom,  if  ever,  required.     (F.) 

Citric  Acid: — This  agent  has  been  used  with  satis- 
factory results.  It  acts  as  a  powerful  deodorizer 
and  possesses  marked  healing  properties.  The  mode 
of  employment  is  as  follows :  Every  morning  the 
nose  should  be  rinsed  out  and  freed  from  pus  and 
crusts.  Then  by  means  of  an  insufflator,  citric  acid 
mixed  w^ith  equal  parts  of  sugar  of  milk  is  intro- 
duced three  times  a  day.  Deodorization  can  be 
noticed  at  once,  and  lasts  for  several  days,  even  if 
the  process  is  not  repeated.  The  secretion  is  also 
speedily  considerably  reduced.  (M.M.  W.,  4,  11,  99.) 

Ichthyol: — Gtt.  xx-xxx,  albolene,  ^ 

Mercuric  Bichloride: — Gr.  ss,  albolene,  5J. 

Potass.  Permang: — Gr.  ss,  aque,  ^j ;  especially  when 
discharge  is  persistent  is  a  good  deodorizer,  but  not 
as  lasting  as  some  others.     (F.) 

Camphor  Menthol: — 10  per  cent,  solution  in  lano- 
line  when  odor  is  very  foul.     (Bp.) 

Thiol: — In  the  follow^ing  combination,  by  means  of 
oil  atomizer,  three  or  four  times  a  daj' : 

9;.    Pulv.  Thioli,  gr.  x. 

Mentholi,  gr.  v. 

Liq.  Blancolini,  gj. 
M.  (T.,98.) 


RHINITIS.  533 

Pheno-Salyl.:— Sol.  1-1000,  with  a  little  salt. 

Creoline:— Sol.  1-1000.     (Al.) 

Hydrastis: — Fid.  ext.,  3j,  aq.  destill.,  Oj.     (B.) 

Labarraque's  Solution: — In  strength  of  15  to  20 
drops  to  the  ounce  is  most  useful  for  correcting  odor. 
(Al.) 

Zinc  Sulphate: — Weak  solutions  have  been  used  to 
cleanse.     (F.) 

Iodine : — In  solutions  of  varying  strengths  is  of 
great  service.  One  of  4  per  cent,  in  lanolin,  and  also 
the  following  may  be  mentioned : 


9;.    lodi, 

•   gr. 

Potass.  lodidi, 

gr- 

Glycerini, 

U 

M. 

Dilute  with  water  as  condition  demands. 

Alcohol: — Diluted  according  to  the  susceptibility 
of  the  patient,  forms  one  of  the  simplest  and  best  ap- 
plications.    (Bn.) 

Nasal  Douche : — In  addition  to  the  spray,  the  pa- 
tient should  use  once  a  day,  by  means  of  the  nasal 
douche,  1  or  2  quarts  of  hot  water  with  salt,  a  half 
ounce  to  the  quart ;  the  water  should  be  used  as  hot 
as  can  be  borne.     (Bos.) 

The  following  powders  may  be  given  by  insuffla- 
tion: Aristol  with  Zinc  Stearate  Compound;  Euro- 
phen,  especially  in  scrofulous  children;  Nosophen; 
lodo-Tannin ;  Calomel,  gr.  v,  with  Sac.  Alb.,  .^ss; 
Zinc  Zozoiodate,  1  part,  with  talc,  10  parts,  when 
an  excitant  action  is  desired. 

Nitrate  of  Silver: — Of  great  benefit.  Solutions  vary 
according  to  the  sensitiveness  of  the  mucous  mem- 
brane; 10  to  40  grains  to  the  ounce  are  recom- 
mended, applied  with  cotton  applicator  every  second 


534  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

or  third  daj^  with  lengthening  intervals.  (Ty.)  At 
home  the  patient  should  use  in  the  morning  the  fol- 
lowing spray : 

$fc.    Hydrarg.  Bichloridi,  gr.  j. 

Aq.  lyaurocerasi,  ^"j- 

Aq.  Destill.,  Oss. 

M. 

In  the  evening;  the  same  followed  by  this  oint- 
ment: 

^.    Hydrarg.  Oxidi  Flavi,  gr.  vj-x. 

Ol.  Bergamottse,  gr.  vj. 

Vaselini,  ^j. 

M. 

Susceptibility  of  some  patients  to  mercury,  espe- 
cia,lly  in  the  nose,  renders  caution  necessary.  The 
applications,  therefore,  may  be  weaker.     (Bn.) 

Iodoform: — In  the  form  of  bougies  or  wafers  con- 
taining 2  to  5  grains,  or  1  grain  by  insufflation. 
(Al.) 

Trichloracetic  Acid: — 10  to  15  per  cent,  aqueous 
solution  applied  tw^o  or  three  times  a  week  by  means 
of  cotton  covered  silver  probe,  and  rubbed  on  points. 
(Sm.) 

Balsam  Pine : — Cotton  tampon,  soaked  with  the 
remedy  and  carried  into  nasal  chambers.     (Al.) 

The  following  ointments  are  commended : 

Europhen  : — 10  per  cent,  ointment  on  cotton  tam- 
pons, left  in  place  half  an  hour. 

Hydrarg.  Oxidi  Flavi: — 10  grains  to  fresh  lard,  1 
ounce,  applied  on  septum  when  there  is  bleeding  or 
ulceration. 

Calendula  or  Hamamelis  Cerates : — For  bleeding 
ulcerations  of  the  septum. 

Creosote: — With  oil  of  anise,  each  10  drops,  vase- 


RHINITIS.  535 

line,  1  ounce ;  a  small  portion  in  the  nostril  forms  a 
useful  application.     (Sm.) 

Cupric  Electrolysis:  —  This  method  has  recently 
been  employed  by  Dr.  McBride,  of  Edinburgh,  who 
reports  eight  cases.  After  cleansing  the  nostrils  an- 
aesthetize with  cocaine  and  apply  the  electricity  as 
follow^s:  A  copper  needle  attached  to  the  positive 
pole  is  inserted  into  the  tissue  lining  of  the  middle 
meatus  and  a  platinum  needle  is  passed  into  the 
septum;  a  current  of  from  3  to  10  milliamperes, 
rarely  the  latter,  is  used.  Each  sitting  lasts  about 
ten  minutes.  Of  the  eight  cases  reported  four  were 
practically  cured  for  long  periods  extending  to  eigh- 
teen months;  in  one  there  was  marked  improve- 
ment, in  one  apparent  cure  lasting  some  months 
w^ith  recurrence,  w^hile  in  two  there  was  improve- 
ment for  a  few  weeks  only.  This  method  is  believed 
by  its  author  to  be  one  of  the  most  valuable  for  the 
treatment  of  ozaena.     (E.  M.  ].,  4,  99.) 

Galvanism: — Dr.  Delevan  recommends  the  follow- 
ing :  The  positive  electrode  is  placed  on  the  nape  of 
the  neck,  and  the  negative,  v^rapped  in  absorbent 
cotton,  is  applied  directly  to  the  nasal  mucous  mem- 
brane; the  strength  of  the  current  is  four  to  seven 
milliamperes,  and  the  duration  seven  to  fifteen  min- 
utes, or  until  a  Mratery  secretion  is  induced  ;  excellent 
results  are  claimed. 

Galvano  -  Cautery  :  —  Recommended  b}^  Lennox 
Browne,  and  others.  The  electrode  is  applied  at 
various  sittings  to  successive  portions  of  the  mu- 
cous membrane  so  as  to  produce  as  many  small 
eschars  as  possible ;  insufflation  of  iodoform  or  iodol 
may  follow  the  applications.  The  use  of  the  galvano- 
cautery  is  regarded  by  other  writers  as  a  measure  to 


536  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

be  employed  only  with  great  caution,  as  it  is  capable 
of  doing  much  harm.  As  a  stimulating  agent  it  is  re- 
garded as  productive  of  good  results  in  the  earlier 
stage  if  applied  with  great  care. 

Vibratory  Massage: — Applied  as  follows:  A  piece 
of  absorbent  cotton,  loosely  torn  from  a  roll,  is  in- 
serted into  the  inferior  meatus,  completely  filling  it 
and  the  space  between  the  middle  of  the  inferior 
turbinated  bone  and  septum.  The  dry  cotton  is  held 
on  a  holder,  and  vibratory  movements  are  carried 
over  the  mucous  membrane  of  the  inferior,  middle 
and  superior  tubinated  bodies,  pharjmx,  septum  and 
floor  of  nose.  From  3  to  6  pledgets  of  cotton  are 
necessary  in  each  nostril  in  order  to  cleanse.  The 
mucous  membrane  after  the  massage  looks  pink  and 
clean,  and  there  is  a  feeling  of  relief  Immediately 
afterward  some  such  application  as  10  per  cent, 
lodoglycerine  may  be  made.  Applications  are  to  be 
made  daily.     (Bp.) 

Electrolysis: — Claims  have  been  asserted  for  a 
large  percentage  of  cures  with  bi-polar  electrolysis. 
20  milliamperes  for  20  minutes  at  each  sitting,  cop- 
per needles  being  inserted  into  the  submucous  tis- 
sues.    (T.,  98.) 

Sea  bathing  is  often  of  great  benefit,  both  from  its 
local  and  constitutional  effect;  residence  by  sea  is 
also  beneficial. 

HYPERTROPHIC  RHINITIS. 

In  the  earlier  stages  spray  applications  will  be 
found  of  great  benefit,  and  will  often  arrest  the  prog- 
ress of  the  disease ;  they  must  be  applied  with  care 
and  thoroughness  under  the  fullest  illumination  and 


RHINITIS.  537 

inspection.     A  large  number  of  formulae  have  been 
suggested,  of  which  the  following  may  be  mentioned : 

^.    Fid.  Ext.  Hamamelidis  Destill., 

Aq.  Rosse,  aa  gij- 

M.  (Bn.) 

^.    Acid.  Carbolici,  gr.  iij. 

Sod.  Bicarbonatis,  gr.  xij. 

Sod.  Boratis,  gr.  xxx. 

Glycerini,  gss. 

Aquae,  ad  gvj. 
M.  (Bos.) 

Acid.  Borici: — Gr.  x-.^j. 

Zinc.  Sulpho-Carbolate: — Gr.  ij— §j. 

Resorcin: — Gr.  v-5J. 

Petroleum  preparations,  such  as  Albolene,  Ben- 
zoninal,  Glycolene,  etc.,  may  be  substituted  for 
aqueous  solutions  when  there  is  great  irritability. 
Various  remedies  may  be  combined  with  these  oils 
w^ith  good  effect,  the  most  useful  being  Oil  of  Euca- 
lyptus, Oil  of  Sassafras,  Oil  of  Pine  Needles,  and 
especially  Menthol,  the  strength  being  from  2  to  6 
grains  to  the  ounce  of  the  petroleum  base.     (Bn.) 

Iodine: — In  cases  of  moderate  fibrous  thickening 
applications  to  the  turbinated  bones  are  valuable. 
Solutions  of  the  crystals,  10  grains,  with  potassium 
iodide,  40  grains,  to  glycerine,  1  ounce  or  from  2  to  5 
drachms  of  the  tincture,  with  enough  glycerine  to 
make  1  ounce.  An  applicator  covered  w^ith  cotton 
should  be  used.     (Bn.) 

When  the  above  line  of  treatment,  combined  with 
proper  hygiene  and  internal  remedies,  has  proved 
ineffective  and  more  energetic  measures  are  required, 
the  following  should  receive  consideration : 

Chromic  Acid: — Soft  and  vascular  enlargements 


538         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

are  best  removed  by  this  agent,  not  used  as  a  general 
escharotic,  but  according  to  the  following  manner : 

First  apply  cocaine,  5  per  cent,  solution,  to  con- 
tract and  anjesthetize  the  parts  to  be  operated  upon. 
This  may  be  done  by  inserting  small  pledgets  of  cot- 
ton, saturated  with  the  cocaine,  betw^een  the  septum 
and  turbinates,  allowing  them  to  remain  five  to  ten 
minutes ;  the  chromic  acid  is  now  to  be  applied,  us- 
ing it  on  the  end  of  a  small  probe  in  the  form  of  a 
fused  bead  or  a  few  crystals  on  a  tightly  wound 
strip  of  moistened  cotton.  The  application  is  made 
to  the  point  of  greatest  hypertrophy,  and  should  be 
kept  applied  about  fifteen  or  twent^^  seconds.  After 
this  the  mass  should  be  sprayed  with  an  alkaline 
solution,  such  as  Dobell's.  The  cauterizations  should 
be  repeated  at  intervals  of  seven  to  twelve  days  until 
phj'siological  respiration  is  attained.  In  the  inter- 
vals sedative  sprays  should  be  applied.     (Bn.) 

Another  method  of  applying  chromic  acid  is  to  in- 
cise the  mucosa,  separate  it  from  the  erectile  tissue 
by  means  of  a  flat  probe  or  spatula,  and  then  insert 
a  probe  with  the  fused  acid  on  its  tip.     (T.,  98.) 

Trichloracetic  Acid: — Has  been  strongly  advised. 
An  aluminum  rod,  w^ith  a  hollow  in  its  distal  ex- 
tremity in  which  a  few  dry  crystals  are  placed,  is 
used.  Applications  are  made  in  the  same  manner  as 
with  chromic  acid.  It  is  claimed  there  is  little  or  no 
inflammationy,  reaction,  and  the  eschar  is  dr\^  and 
aseptic.     (Bn.) 

Galvano  -  Cautery :  —  When  decided  fibro-elastic 
changes  have  taken  place,  more  energetic  treatment 
is  required ;  for  these  conditions  the  galvano-cautery 
is  the  best  method ;  with  it  there  is  no  reaction,  and 
no  difficulty  in  limiting  the  amount  of  destruction. 


RHINITIS.  539 

The  application  may  be  repeated  every  three  or  four 
days,  or  as  soon  as  the  eschar  has  disappeared. 
(Bos.) 

The  Snare  or  Electric  Trephine  (Whiting)  are 
methods  to  be  preferred  for  the  reduction  of  hyper- 
trophy of  the  turbinated  bones.  Septal  hypertrophies 
are  best  treated  with  the  Saw,  Dull  Chisel,  or  Knife. 
(Iv.) 

When  fibro-elastic  changes  have  progressed  so  far 
that  much  of  the  turbinated  tissue  has  become  tendi- 
nous in  structure  the  outlook  for  cure  is  unfavorable, 
though  much  can  be  accomplished  in  securing  com- 
fort and  arresting  the  progress  of  disease.  The  use 
of  alterative  spra3'S,  such  as  those  agents  mentioned 
under  Chronic  Rhinitis,  especially  solutions  of  Thy- 
mol, Zinc  Iodide,  and  Zinc  Sulpho-Carbolate,  are  of 
great  value.  The3^  must  be  applied  at  first  daily  and 
toward  the  end  of  four  to  fourteen  months'  treat- 
ment once  a  fortnight.  The  Snare  or  Curette  should 
be  used  in  this  stage  to  remove  myxomatous  and 
papillomatous  tissue.     (Bn.) 

Faradism  : — Valuable  in  the  advanced  stages,  us- 
ing a  straight  nasal  electrode,  long  enough  to  reach 
the  pharyngeal  wall  when  introduced  through  the 
nostril.    The  current  should  be  carefully  applied. 

General  hygienic  measures  are  of  great  importance. 
Riding,  bicycling,  regular  and  frequent  bathing,  dailj' 
sponging  face,  neck,  and  chest  w^ith  cold  w^ater  v^rill 
be  found  of  benefit.  Forcible  efforts  to  clear  the  nos- 
trils are  to  be  avoided,  as  they  increase  the  general 
irritation. 

The  matter  of  clothing  should  receive  attention, 
care  being  observed  that  it  is  sufficiently  warm  for 


540  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

the  season.     "Catching  cold"  should    be   carefully 
guarded  against. 


RING  WORM. 

See  Trichophytosis. 

SCABIES. 

Before  attempting  any  of  the  various  methods  of 
treatment,  the  condition  of  the  patient's  skin  must 
be  considered.  If  highly  irritated  or  covered  v^ith  an 
inflamed  eruption,  it  must  be  treated  with  Bran 
Baths,  soothing  ointments,  such  as  Zinc  Oxide  or 
Bismuth  Subnitrate,  in  the  proportion  of  1  drachm 
to  1  ounce  of  Ung.  Aq,  Rosae.  A  soon  as  the  skin  is 
in  condition  one  of  the  follow^ing  methods  may  be 
employed  (B.  H.): 

Sulphur: — A  time-honoTed  and  effective  remedy  is 
used  in  various  forms  and  combinations.  An  oint- 
ment of  2  drachms  to  the  ounce  is  recommended  by 
Kippax,  applied  in  the  foUov^'^ing  manner:  The  pa- 
tient first  takes  a  hot  bath  w^ith  plenty  of  soap,  then 
the  ointment  is  rubbed  in  thoroughly  over  the  w^hole 
body,  and  allowed  to  remain  on  over  night;  in  the 
morning  another  hot  soap  and  water  bath  should  be 
taken ;  the  same  programme  is  followed  every  night 
until  every  trace  of  itching  has  disappeared.  In  the 
majority  of  instances  three  days  will  effect  a  cure. 
(Kp.) 


SCABIES.  541 

Fournier  recommends  for  private  practice  a  prelim- 
inary rubbing  with  good  toilet  soap ;  then  the  appli- 
cation of  Bourguignon's  ointment,  which  is  as  fol- 
low^s: 


Glycerine, 

200  parts. 

Gum  Tragacanth, 

5  parts. 

Sublimated  Sulphur, 

100  parts. 

Carbonate  of  Potassium, 

35  parts. 

Oil  of  Lavender, 

Oil  of  Peppermint, 
Oil  of  Cloves, 

each  i}i  parts. 

Oil  of  Cinnamon, 

This  is  followed  by  baths  and  powders  of  com 
starch.  It  is  contra-indicated  in  adults  when  much 
excoriation  is  present,  and  should  never  be  applied 
in  the  case  of  children. 

The  following  method  is  that  of  Bazin  and  Hardy ; 
it  is  recommended  as  highly  effective  if  the  patient  is 
an  adult  and  the  skin  is  not  over-sensitive ;  it  is  di- 
vided into  three  stages : 

1.  Patient  scrubs  and  washes  himself  in  lukewarm 
w^ater  with  green  soap  all  over,  except  face  and  head, 
for  twenty  minutes. 

2.  Patient  then  soakes  in  a  lukewarm  bath  for 
twenty  minutes. 

3.  Rub  all  over  body  for  twenty  minutes,  except 
head  and  face,  paying  special  attention  to  the  part 
covered  with  the  eruption,  the  foUow^ing  ointment 
known  as  Hardy's  modification  of  Helmerich's 
pomade : 

9;.    Potass.  Carbonatis,  33. 

Sulphur.  Prsecipitati,  ^ij. 

Adipis,  ^  iss. 
M. 


542  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

The  ointment  is  allowed  to  remain  on  the  surface 
for  twent^^-four  hours.  It  should  be  so  prepared  as 
not  to  contain  any  undissolved  particles  of  the  pot- 
ash. A  bath  is  now  given,  and  the  skin,  w^here  ex- 
coriated, is  dressed  v^dth  zinc  oxide,  1  drachm,  ben- 
zoin ointment,  1  ounce,  and  a  little  starch  dusted  on. 
This,  it  is  said,  rarely  fails  to  eradicate  the  disease. 
The  application  may  be  repeated  once  or  twice  if 
necessary.  If  any  irritation  of  the  skin  remains,  ad- 
minister bran  baths  for  a  week  or  so.     (B.  H.) 

Wilkinson's  ointment,  modified  as  follows: 

-t*.    Sulphur.  Sublimati, 

Ol.  Cadini,  aa  ^ss. 

Cretae  Praeparatatse,  ^iiss. 

Sapo.  Viridis, 

Adipis.  aa  ^j. 

M. 

This  is  only  fit  for  hospital  use,  as  it  is  most  dis- 
agreeable, though  effective.     Qa.) 

/3-Naphthol: — Recommended  in  10  per  cent,  oint- 
ments, or  in  the  following  combination : 

9r.    ^3-Naphtholi,  gr.  Ixxx. 

Saponis  Viridis,                    .  ^  ss. 

Pulv.  Cretae  Albse,  gr.  j. 

Adipis^  gj. 

Sig.     Apply  every  morning  for  five  or  six  days  and  adminis- 
ter a  bath  every  second  day.     (Kap. ) 
M. 

It  is  w^ell  adapted  to  cure  the  eczemas  which  often 
accompany  this  affection.  Van  Harlingen  saj^s  that 
he  has  used  for  years  one  or  the  other  of  the  follow- 
ing formulae  exclusively  for  this  affection,  viz.: 

9;.    Pulv.  Naphtholi,  3J, 

Ung.  Adipis,  gj. 

M. 


SCABIES.  543 

]^.    Pulv.  Naphtholi,  ^iss. 

Saponis  Viridis,  3  v. 

Pulv.  Cretse  Albse,  3J. 

Axungise,  ^[x. 
M. 

The  latter  is  adapted  for  coarse  skins : 

Balsam  Peru  :* — Is  recommended  for  young  chil- 
dren and  infants,  and  for  feeble  patients  with  second- 
ary eruptions.     For  children : 

9;.    Balsam.  Peruviani,  3iij- 

Ichthyoli,  3ss. 

Lanolini,  5ij. 

Ung.  Aq.  Rosae,  ^iv. 

Albolini  (Liq.),  ^ij. 
M.  (T.,98.) 

5t.    Balsam.  Peruviani, 

Sulpliuris,  aa.  3j. 

Adipis,  5j. 

M.  (B.  H.) 

For  adults : 

Ijfc.    Balsam.  Peruviani,  3  v. 

^J-Naphtholi,  3J. 

Adipis,  ^vj. 
M.  (T.,97.) 

The  patient  is  rubbed  at  night  for  fifteen  to  t-wenty 
minutes,  and  sleeps  in  a  nightshirt  impregnated  with 
the  balsam.  The  next  morning  a  warm  bath,  with 
plenty  of  soap,  is  given.  It  is  claimed  the  vapor  of 
the  balsam  kills  the  parasite. 

Styrax : — The  use  of  this  remedy  within  the  last 

*  Note. — The  use  of  balsam  of  Peru  is  not  wholly  without  dan- 
ger, as  this  agent  has  been  known  to  cause  nephritis.  It  should 
not,  therefore,  be  used  when  there  is  any  kidney  lesion  present  or 
any  tendency  in  that  direction.  When  applied  the  urine  should 
be  examined  at  frequent  intervals. 


544    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

few  years  has  been  revived.    The  follow^ing  formulae 
are  recommended  as  efficient : 

^.    Liq.  Styracis,  ^j. 

Adipis,  gij. 

M. 

Or, 

9;.    Styracis,  gj. 

Spts.  Villi  Rectificati,  jij. 

Ol.  Olivse,  3j. 

M. 

Sig.     Rub  the  parts  thoroughly,  and  repeat    in    twenty-four 
hours.     ( And. ) 

A  w^arm  bath  should  precede  the  application  of  the 
remedy.  In  one  hundred  and  twenty-four  cases  thus 
treated  by  Unna,  albumen  appeared  in  the  urine  in 
nine.  The  treatment,  however,  w^as  generally  suc- 
cessfiil.    (N.) 

The  foUow^ing  combination  with  Sulphur  is  recom- 
mended as  being  efficient  in  six  rubbings : 

9;.    Sulphur.  Sublimati,  3j. 

Sapo.  Viridis,  gij. 

Styracis  Liquid. ,  3  iss. 

Cretae  Prseparatse,  .  3J. 

Ung.  Aq.  Rosae,  q.  s.  ad   ^j. 

M.  (T.,98.) 

Oxynaphthoic  Acid,  powdered  chalk  and  green 
soap,  each  80  grains,  with  lard  to  1  ounce,  or  Creo- 
lin  30  grains  with  lard  1  ounce  are  said  to  act  very 
quicklj^  without  irritating  the  skin. 

All  underclothing  and  bedding  must  be  burned  or 
disinfected. 


SCARLET  FEVER.  545 


SCARLET  FEVER. 

High  temperature  does  not  require  very  active 
treatment  unless  organic  or  functional  disturbances 
of  the  heart  or  brain  are  threatened ;  as  long  as  these 
two  organs  perform  their  functions  naturally,  the 
temperature  may  be  let  alone. 

Baths: — For  high  temperature  and  non-appearance 
of  eruption : 

If  in  thirt^'-six  hours  the  eruption  does  not  de- 
velop, place  the  patient  in  a  water  bath  at  100°  for 
ten  minutes.  If  there  is  no  appearace  of  eruption, 
repeat  it  three  or  four  hours.  If  the  second  bath  has 
no  effect,  and  especially  if  the  temperature  remains 
high  (above  104.5°),  and  the  patient  is  becoming 
drowsy,  a  cool  bath  at  a  temperature  of  80°  must  be 
administered,  cooling  the  water  gradually  dow^n  to 
65°.  The  low  temperature  is  indicated  if  the  fever 
does  not  fall.  If  the  cool  bath  fails,  or  if  in  spite  of 
reducing  the  temperature  the  cerebral  symptoms  re- 
main, dash  the  face  and  upper  part  of  trunk  with 
water  at  50°  to  60°.  For  this  purpose  the  patient 
may  be  placed  upon  a  rubber  sheet,  and,  if  conveni- 
ent, a  small  hose,  with  attachments  to  both  the  hot 
and  cold  water  spigots,  so  that  the  temperature  can 
be  regulated,  may  be  played  upon  the  patient.  The 
value  of  this  treatment  is  not  alone  for  the  reduction 
of  temperature,  but  for  its  stimulating  effects  upon 
the  depressed  nerve  centres.  It  must  be  administered 
w^ith  judgment  and  care,  and  not  employed  unless 
the  temperature  is  105°,  and  so  persists,  with  increas- 
ing severity  of  cerebral  symptoms.  (Gn.) 
36 


546  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

In  malignant  scarlet  fever  with  hyperpyrexia,  cold 
baths  must  be  used  freely,  for  unless  the  temperature 
goes  down  the  patient  may  die  in  a  few  hours. 

Cold  Packs: — Are  invaluable,  especiallj^  at  the  onset 
of  the  disease,  when  the  eruption  does  not  appear 
and  the  temperature  is  high  (Rd.);  they  are  also  in- 
dicated in  septic  forms  and  those  marked  bj^  per- 
manent cerebral  symptoms.  (Hit.)  The  packs  may 
be  repeated  several  times  at  intervals  of  an  hour  as 
long  as  the  fever  remains  high. 

They  may  take  the  place  of  cold  baths,  which  are 
not  approved  of  by  some  writers.  Holt  regards  cold 
packs  as  superior  to  medicinal  antipyretics,  and  as 
almost  as  effective  as  the  bath ;  they  are  also  much 
easier  to  administer  and  less  likely  to  excite  opposi- 
tion on  the  part  of  the  friends. 

Mustard  Baths: — Of  great  service  when  there  is 
retrocession  of  the  eruption.  Use  a  drachm  to  the 
gallon.     (Al.) 

Sponging: — With  cool  or  tepid  water  is  useful  in 
many  cases  when  the  temperature  is  high,  and  the 
pulse  frequent  and  feeble.     (Jac. ) 

Hot  Baths: — Indicated  when  the  surface  and  ex- 
tremities are  cold,  pulse  frequent  and  filiform.  Strong 
friction  should  be  applied  in  conjunction  with  the 
baths.     (Jac.) 

W^arm  Baths: — At  a  temperature  of  95°  were  ad- 
ministered in  110  cases  twice  a  day.  Nephritis  did 
not  occur  and  desquamation  was  mild.     (T.,  98.) 

Hot  ^Vate^  Enemata: — May  be  employed  in  the 
same  conditions  calling  for  hot  baths.     Qac.) 

Cold  to  the  Throat: — Often  very  comforting  and 
effective  in  allying  glandular  inflammation.     Little 


SCARLET  FEVER.  547 

rubber  bags  of  ice,  or  ice  wrapped  in  dry  cloths,  may 
be  used.     (Tj.) 

Anointing  the  Body  with  Oils : — This  constitutes  a 
useful  adjuvant  in  allaying  irritation  of  the  skin,  and 
in  preventing  the  scales  from  flying  about  during  the 
stage  of  desquamation.  Suet,  sweet  oil,  vaseline,  or 
cocoa  butter  may  be  used  for  this  purpose,  the  latter 
being  preferable. 

Oil  of  Eucalyptus:  —  Remarkable  results  are  re- 
ported from  the  use  of  this  remedy;  the  body  was 
carefully  rubbed  all  over  with  the  oil  three  times  a 
day  for  three  days ;  then  a  bath  was  administered, 
followed  by  another  anointing  -with  the  oil.  Euca- 
lyptus was  also  sprayed  into  the  patient's  mouth, 
nose  and  throat,  and  into  the  atmosphere  of  the 
room.     (Sj.) 

The  following  is  also  commended  for  smearing  on 
the  skin  after  a  warm  bath : 

9;.    Acid.  Carbolici,  .    gj. 

01.  Eucalypti,  ^ij-iv. 

Ol.  Amygdalae, 

01.  Olivae,  aa  ^viij. 

M.  (T.,96.) 

Ichthyol : — A  5  per  cent,  lanolin  ointment  is  useful, 
w^hen  simple  oily  applications  have  failed,  for  severe 
irritation  of  the  skin  which  appears  to  cause  restless- 
ness and  high  temperature.     (T.,  96.) 

For  the  cleansing  and  disinfection  of  mouth, 
pharynx,  and  nares,  the  following  solutions  are 
used,  of  which  the  first  is  preferred : 

Hydrogen  Peroxide,  1-3. 

Mercuric  Bichloride,  1-10,000. 

Carbolic  Acid,  1-60. 

Liq.  Sod.  Chlorinatae,  1-10. 


548         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Boric  Acid,  1-15. 

Potass.  Permang.,  1-250. 

Sulphurous  Acid,  1-10. 

Cleansing  the  nares  and  naso-pharynx  may,  it  is 
said,  prevent  extension  of  suppuration  to  the  eusta- 
chian tube.  The  nostrils  should  be  spraj^ed  with  an 
alkaline  solution  and  then  with  the  following : 


^.    Mentholi, 

gr.  XX 

Eucalyptoli, 

M.x. 

Fid.  Paraffini, 

ad  Ij. 

M. 

Sig.     Apply  every  3  or  4  hours. 

( 

(T.,  97.) 

Hydrogen  Peroxide : — Should  constitute  the  sole 
local  treatment  for  the  otitis  during  the  stage  of  in- 
flammation .     ( Gn . ) 

Caustics  may  be  required  if  there  is  much  slough- 
ing of  tonsils.  First  cleanse  the  parts,  then  apply 
such  agents  as  Nitrate  of  Silver  or  Chinoline,  2  to  5 
per  cent,  in  alcohol.     (A.  W.) 


SCIATICA. 

The  remedies  mentioned  for  Neuralgia,  Lumbago 
and  Chronic  Rheumatism,  are  applicable  to  this  con- 
dition. 


SCORBUTUS. 

Antiseptic  and  astringent  mouth  washes,  as  found 
under  Stomatitis,  are  applicable  to  this  condition. 

Nitrate  of  Silver: — One  of  the  best  applications  for 
the  ulcers.     (Ty.) 


SEBORRHCEA.  549 

Hydrochloric  Acid: — For  applications  to  the  gums, 
viz.: 

^.    Acid.  Hydrochloric,  Dilut.,  3J. 

Mellis, 

Aq.  Rosae,  aa   §j. 

M. 
Sig.     Apply  to  gums  three  or  four  times  a  day.     (Sn.) 

Compresses  saturated  with  Aromatic  Vinegar  or 
Spirits  of  Camphor  are  very  useful  for  the  ecchymosis 
and  infiltration.     (Rd.) 

Turpentine: — The  undiluted  oil  painted  on  the 
gums  hourlj^  will  cause  the  buccal  haemorrhage  to 
cease.    (F.) 


SEBORRHCEA. 

When  located  on  the  scalp  the  scales  must  be  first 
removed ;  this  may  be  accomplished  if  the  scales  are 
hard  by  soaking  the  scalp  over  night  in  Oil,  and  re- 
moving the  softened  scabs  with  hot  water  and  Cas- 
tile soap,  or  by  shampooing  mth  Spirits  of  Green 
Soap,  using  about  a  drachm  with  a  sponge  and  con- 
siderable water ;  after  rubbing  vigorously  for  a  few 
minutes,  cleanse  with  clear  w^arm  water,  and  dry 
w^ith  a  soft  tow^el.  If  the  scalp  is  sensitive  a  good 
toilet  soap  should  be  used.  After  the  preliminary 
cleansing  the  remedy  may  be  applied,  viz.: 

Captol: — Strongly  recommended  by  EichofF,  who 
employs  it  in  1  to  2  per  cent,  alcoholic  solutions  and 
in  the  follow^ing  combination : 


550  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

T^.    Captol., 

Chloral.  Hydratis, 

Acid.  Tartarici,  aa  gr.  xvss. 

01.  Ricini,  gtt.  viiss. 

Spts.  Vini  (65  per  cent.),  5^^v  M.xv. 

Ess.  Flor.  Auratit.,  5^3  M.xlvij, 

M. 

Under  the  influence  of  this  remedy  in  from  eight  to 
fourteen  days  the  scabs  and  hypersecretion  disap- 
pear and  the  falling  out  of  the  hair  ceases.     (T.,  99.) 

Carbolic  Acid: — Most  efficient;  employ  in  the  fol- 
lowing combination : 

5t.    Acid.  Carbolici,  9j-3iss. 

01.  Ricini,  9ij. 

01.  Limonis,  53- 

Aq.  Coloniensis,  ^ij. 

M.  (Vn.) 

Resorcin: — In  oil  or  vaseline,  5  per  cent.,  or, 

5fe.    Resorcini,  gr.  xx. 

Alcoholis,  5ij- 

Vaselini,  5vj- 

M.  (T.,97.) 

Sulphur: — Regarded  as  one  of  the  most  satisfac- 
tory remedies;  a  solution  of  1  ounce  to  water,  1 
quart,  is  used  applied  to  the  head  daily  (T.,  97.);  a 
solution  of  1  drachm  in  sweet  oil  1  ounce,  rubbed  in 
the  scalp  thouroughly  nightly  for  a  w^eek,  wrapping 
the  head  in  a  tow^el  or  w^earing  a  night  cap.  During 
the  second  week  the  applications  are  made  every 
other  night,  and  after  that  reduced  in  frequency. 
(Ja.)  Vlemingckx's  solution,  as  described  in  the 
treatment  of  Acne  Simplex,  is  suitable  for  the  disease 
when  located  on  the  face. 

Zinc  Sulphide: — Duhring  recommends  the  salt  ob- 


SEBORRHCEA.  551 

tained    by  double    decomposition  in    the  following 
lotion : 

$fc.    zinc.  Sulphatis, 

Potassii  Sulphidi,  aa  3ss. 

Aq.  Rosae,  5"j- 

Alcoholis,  3"j~vj. 

M.  (F.) 

Mercurial  Ointments: — The  following  is  for  use 
upon  the  scalp : 

1^.    Ung.  Hydrarg.  Nitratis,  3J-iv. 

Ol.  Cadini,  3J. 

Ol.  Olivae,  3ij. 

Lanolini,  ^iv. 
M. 

Well  rubbed  in  at  night,  and  washed  off  in  morning  with  borax, 
3ij,  water,  Oj;  then  rub  in  a  little  almond  oil. 

The  ung.  hydrarg.  flav.  may  be  used  instead  of  the 
nitrate,  with  or  without  ths  oil  of  cade.     (Ck.) 

An  ointment  of  White  Precipitate  and  Tar  is  as 
follows : 

^.    Hydrarg.  Ammoniati,  ^iss. 

Picis  Iviquidae,  ^ss. 

Ung.  Petrolii,  ^j. 
M.  (And.) 

Bronson  recommends  for  private  practice,  as  a  sub- 
stitute for  sulphur,  the  following : 


T^.    Hydrarg.  Ammoniati, 

9j-ij. 

Hydrarg.  Chloridi  Mitis, 

9ij-iv. 

Vaselini, 

n 

M. 

Hydrarg.  Bichlorid.:— A  useful  ointment  is  as  fol- 
lows: 


552    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

9?.    Hydrarg.  Bichloridi, 

Spts.  Villi  Rectificati, 

Glycerini  (Price's), 

Aq.  Destill., 
M. 

For  the  face  and  scalp 

9(.    Hydrarg.  Bichloridi, 

Aq.  Rosae, 
M.  (Sh.) 

Hydrastine: — An  ointment  of  this  remedy,  recom- 
mended by  Shoemaker,  as  follows : 


gr- 

XIJ. 

3j- 

3ij 

3v. 

(And. 

.) 

gr. 

ij- 

U 

Hydrastinae  Hydrochloratis, 

gr.  v-xx. 

Naphtholi, 

3SS. 

Tr.  Quaillaise, 

gss. 

Tr.  Hamamelidis, 

q.  s.  ad  ^iv. 

(Sm.) 

M. 

Salicylic  Acid,  3  per  cent,  in  Castor  Oil,  Solution 
of  Chloral,  a  drachm  to  the  ounce,  Tannic  Acid,  a 
drachm  to  the  ounce  of  rice  powder  for  the  face,  are 
other  useful  applications.     (Ja.)     (Kp.) 

For  irritation  after  removal  of  the  scales,  a  plain 
dusting  powder,  viz.: 

9^.    Acid.  Salicylici,  gr.  x. 

Zinc.  Oxidi, 

Aniyli  Oryzae  vel  Maydis,  aa  ^j. 

M.  (B.  H.) 

Sig.     Used  for  a  few  days. 

For  Seborrhoea  of  the  Genitals,  absolute  cleanli- 
ness, dusting  powders  and  antiseptic  lotions,  such  as 
those  of  Ichthyol  and  Bichloride  of  Mercury,  are 
generally  indicated. 

For  Seborrhoea  Oleosa  use  Sulphur,  which  is  the 
most  efifective.  Oil  of  Cade,  Ichthyol  or  Resorcin  in 
some  penetrating  medium.     Tannic  Acid  in  the  pro- 


SEPTICEMIA.  553 

portion  of  half  a  drachm  or  a  drachm  to  the  ounce  of 
vasehne  is  useful  for  the  disease  on  the  body  and 
scalp. 


SEPTICAEMIA- PYiEMIA— SEPTICO- 
PYEMIA. 

In  all  cases  the  primary  seat  of  infection  should  be 
ascertained,  and  the  most  rigid  antisepsis  applied 
according  to  the  nature  of  the  lesion.  Septic  wounds 
should  be  laid  open  by  free  incisions,  scraped  with 
the  sharp  curette,  freely  irrigated  with  hydrogen  per- 
oxide or  mercuric  bichloride,  1-1000  or  2000,  and  in 
some  instances  cauterized  with  pure  carbolic  acid. 
Free  drainage  should  be  established  by  means  of 
tubes  or  iodoform  gauze.  Dressings  should  be  fre- 
quently changed  so  that  the  cavity  of  the  wound  can 
be  irrigated.  Bichloride  gauze  may  be  used  for  dress- 
ing until  sloughing  appears,  when  antiseptic  fomen- 
tations will  be  indicated.  Punctured  w^ounds  must 
be  laid  open  their  entire  depth,  scraped,  cauterized 
with  carbolic  acid  and  packed  with  iodoform  gauze. 
Inflamed  glands  may  be  painted  with  iodine,  and 
afterwards  coated  w^ith  ichthyol ;  if  suppurating, 
they  should  be  incised  and  treated  antiseptically. 
Cellulitis  demands  multiple  incisions,  septic  cystitis 
bladder  irrigation,  and  in  grave  forms  suprapubic  or 
perineal  section.  Puerperal  infection  calls  for  irriga- 
tion with  bichloride  solutions  of  1-2000,  and  curet- 
tage of  the  uterine  cavity  followed  by  irrigations  of 
the  same  solution.  In  septic  peritonitis  the  chances 
of  recovery  w^ill  be  enhanced  by  laparotomy  and 
copious  irrigations  with  normal  saline  solution.     In 


554  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

short,  pus,  wherever  located,  must  be  evacuated,  and 
septic  infection,  wherever  seated,  must  be  eradicated. 

In  conjunction  w^ith  these  measures  the  following 
have  given  results  Avhich  command  attention,  the 
cases  in  which  they  have  been  employed  w^ere  those 
of  the  gravest  nature  where  other  remedial  agents, 
both  local  and  constitutional,  had  failed: 

Antistreptococci  Serum: — The  reports  of  the  re- 
sults of  administration  of  this  remedy  in  severe  cases 
of  septic  infection  are  favorable.  Attention  is  called 
to  the  statement  of  Marmorek,  that  the  action  of  the 
serum  is  limited  to  those  forms  of  sepsis  which  arise 
from  the  presence  of  the  streptococcus  pyogenes,  the 
most  common  form  of  septicaemia ;  infections  due  to 
the  staphylococcus,  the  bacillus  coli  communis,  the 
gonococcus,  and  the  Talamon-Fraenkel  coccus  are 
not  amenable  to  the  action  of  the  serum.  The  rem- 
edy is  given  by  subcutaneous  injection  into  the  are- 
olar tissue  of  the  lateral  abdominal  wall.  The 
syringe  and  skin  should  previously  receive  the  most 
thorough  sterilization  and  antisepsis,  respectively. 
The  surface  should  be  prepared  by  washing  with  an 
ethereal  solution  of  soap,  then  washed  with  bi- 
chloride, 1-1000,  and  sprinkled  with  boric  acid.  The 
dose  ranges  from  30  to  45  c.c.  in  twenty-four  hours. 
The  usual  dose  is  first  15  c.c,  and  after  twelve 
hours,  10  c.c;  in  severe  cases  25  c.c.  for  the  first 
dose,  repeated  at  the  end  of  twenty-four  hours.  The 
British  Institute  of  Preventive  Medicine  recommends 
20  c  c  for  the  initial  dose,  followed  by  the  same 
quantity  if  the  temperature  does  not  fall.  At  present 
the  practitioner  must  rely  upon  the  instructions 
which  accompanj^  each  article  of  serum.  (T.,  99.) 
(B.  M.  J.,  10,  31,  96.) 


SEPTICEMIA.  555 

Collargolum: — This  is  a  non-poisonous  allotropic 
silver  which  is  permanently  soluble  in  water  and  al- 
buminous fluids,  and  is  an  effective  general  anti- 
septic which  can  be  introduced  into  the  system  with- 
out causing  either  local  reaction  or  general  poison- 
ous effects.  It  remains  metallic  silver  in  sterile  blood 
or  lymph ;  but  in  the  presence  of  pathogenic  bacteria 
or  their  toxins  it  enters  into  combination,  and  acts 
as  an  antitoxic  agent.  Introduced  into  the  system 
by  inunction  of  the  ointment,  or  hypodermically,  or 
by  the  mouth  in  capsules,  or  in  solution,  or  applied 
locally  to  w^ounds,  it  enters  the  lymphatics,  and  cir- 
culates dissolved  in  the  blood.  The  faeces  frequently 
become  brownish-black,  but  argyria  never  occurs. 

Collargolum  is  usuallj^  best  employed  in  the  form 
of  the  Unguentum  Crede,  as  an  inunction;  any  sur- 
face of  the  body  maj'^  be  selected,  preferably  the  back, 
buttocks  and  loins.  The  single  dose  for  adults  is  3 
grams  (45  grains);  for  adolescents  2  grams  (30 
grains);  and  for  children  1  gram  (15  grains);  to  be 
thoroughly  rubbed  into  the  cleansed  skin  for  from 
t^renty  to  thirty  minutes,  and  not  w^ashed  off. 
Three  inunctions  upon  three  successive  days  are  re- 
quired in  all  cases,  and  the  ointment  is  to  be  used 
subsequently  as  indicated. 

The  remedy  has  been  successfully  employed  in  pure 
and  mixed  forms  of  infections  of  staphylococcus  and 
streptococcus  and  other  bacilli.  In  recent  cases  it  is 
said  to  exert  a  rapid  curative  action  ,and  in  those  of 
a  more  chronic  nature  it  is  also  effective  provided  it 
is  used  before  secondary  changes  in  the  vital  organs 
have  occurred.  Very  favorable  reports  of  the  effects 
of  this  agent  have  been  published.  It  has  been  em- 
ployed in  conjunction  with  injections  of  antistrepto- 


556  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

cocci  serum.  (N.  Y.  M.  J.,  6,  17,  99,  a.)  (D.  M.  W., 
3,  9,  99.) 

Saline  Solution: — Intravenous  or  subcutaneous  in- 
jections of  normal  saline  have  given  favorable  results 
in  grave  forms  of  infections  of  all  varieties.  As  it  is 
not  likely  that  the  small  amount  of  saline  fluid 
which  is  introduced  into  the  circulation  can  produce 
destruction  of  the  toxins,  it  is  probable  that  a  re- 
nev^^al  of  physiological  action  is  induced.  Whatever 
the  action,  this  agent  has  proved  to  be  a  means  of 
saving  life.     (F.) 

Strychnia: — Hypodermic  doses  of  -^^  to  ^  grain 
every  two  to  four  hours  w^ill  be  found  one  of  the 
most  reliable  remedies  to  sustain  the  heart's  action 
in  septic  conditions  when  indications  point  to  reme- 
dies of  this  class.     (J.  C.  W.) 


SHOCK— COLLAPSE. 

Heat: — In  the  form  of  hot  water  bags  and  bottles 
should  always  be  applied  to  the  extremities  and  sides. 

Strychnia: — Indicated  in  all  forms  of  shock.  It 
should  be  given  subcutaneously  in  full  doses,  ^V  ^o  tV 
grain.  Larger  doses  have  recently  been  advocated. 
Dr.  J.  B.  Hall  (British  Medical  Journal,  Nov.  25, 
1899)  reports  two  cases  of  severe  shock  during 
operation,  with  impending  death,  in  w^hich  ^  grain 
w^as  injected  with  successful  results.  The  same 
writer,  while  not  advocating  this  amount  for  routine 
practice,  regards  not  less  than  j\  grain  as  the  proper 
dose  w^hen  the  remedy  is  indicated. 

\Vhiskey  or  Brandy: — May  be  injected  hypodermi- 


SHOCK — COLLAPSE.  557 

cally,  the  latter  every  ten  minutes  in  half  drachm 
doses  until  reaction.     (A.) 

Digitalis: — 15  minims  everj^  fifteen  minutes  hypo- 
dermically.  Atropine  y^^  grain  may  be  given  with 
the  first  dose  of  Digitalis.     (A.) 

Aqua  Ammoniae: — 10  to  60  drops  diluted  with 
from  1  to  8  drachms  of  sterilized  water,  injected  into 
a  vein,  is  of  great  lienefit.     (F.) 

Turpentine  Enema: — Half  an  ounce  rubbed  up 
w^ith  raw  egg  in  the  form  of  an  emulsion  is  a  power- 
ful stimulant.     (A.) 

Camphorated  Oil: — 1  part  of  camphor  to  9  parts 
of  aseptic  SAveet  oil  in  doses  of  15  minims,  hypo- 
dermically,  is  a  prompt  and  powerful  stimulant  in 
cases  of  sudden  prostration.     (F.) 

The  following  line  of  treatment  is  for  collapse  after 
a  prolonged  operation,  extensive  loss  of  blood,  and 
shock  following  severe  injuries :  Place  the  patient  in 
such  a  position  that  the  head  will  be  lower  than  the 
body,  apply  around  him  hot  water  bottles  and  bags, 
and  rub  actively;  administer  hypodermics  of  Ether 
or  Caffeine.  Brandy  will  be  found  beneficial;  like- 
wise Champagne  by  the  rectum.  For  the  purpose  of 
stimulating  the  heart  a  momentary  whiff  of  Nitrite 
of  Amyl,  and  for  stimulating  the  respiration,  slap 
the  face  with  a  wet  towel,  also  use  Laborde's  rhyth- 
matic  tractions  of  the  tongue,  inhalations  of  Oxy- 
gen and  Silvester's  method  of  Artificial  Respiration. 
<T.,  97.) 

Normal  Saline  Solution: — By  transfusion  or  sub- 
cutaneous injection  Avill  be  found  of  the  greatest  ser- 
vice when  haemorrhage  is  the  cause  and  should  be 
employed  in  severe  cases. 

Beef  Extract: — In  large  doses  by  enema  with  hot 
water  acts  rapidly.     (P.) 


558  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

SIGMOID   FLEXURE   AND  UPPER 
RECTUM,  DISEASES  OF. 

The  employment  of  the  Protoscope  and  Sigmoido- 
scope is  of  invaluable  service.  The  ability  to  recog- 
nize various  lesions  in  their  incipience',  establishing 
the  diagnosis  beyond  doubt,  enables  one  by  the 
prompt  administration  of  appropriate  treatment  to 
attain  excellent  results.  The  pictures,  as  viewed 
through  the  proctoscope,  are  characteristic  of  neo- 
plasms, including  carcinomata  and  fibrous  and  ade- 
noid polypi,  and  such  non-surgical  diseases  as  simple 
acute  catarrh,  hypertrophic  catarrh,  and  atrophic 
catarrh.  In  the  latter  conditions  the  treatment  con- 
sists chieflj^  in  copious  Irrigation  with  saline  or  mild 
antiseptic  solutions ;  in  cases  of  atrophic  catarrh  a 
5  to  10  per  cent,  solution  of  Argonin  has  been  found 
to  be  particularly  efficient,  while  in  cases  of  hyper- 
trophic catarrh  the  aqueous  fluid  extract  of  Kra- 
meria  is  regarded  as  almost  a  specific.  (N.  Y.  M.  J., 
2,  7,  98.) 

SPERMATORRHCEA— CHRONIC   SEM- 
INAL VESICULITIS  AND  AM- 
PULLITIS.* 

Sleeping  in  the  dorsal  position  should,  if  possible, 
be    avoided,  as  it    is    apt  to  induce  pollutions.    A 

*  Note. — ^This  entire  article,  with  the  exception  of  the  paragraph 
on  "  Stripping  of  the  Seminal  Vesicles,"  is  an  abstract,  by  permis- 
sion, of  the  treatment  of  this  disorder,  as  described  by  Dr.  Bukk 
G.  Carleton,  in  his  work  on  the  subject.  See  Cln.  in  Reference 
Key. 


SIGMOID  FLEXURE  AND  UPPER  RECTUM.  559 

knotted  towel  tied  around  the  waist,  or  a  block  of 
wood  held  in  position  by  tapes  and  placed  in  the 
small  of  the  back,  will  cause  the  patient  to  aw^aken 
^vhen  he  turns. 

Cold  Baths : — A  general  cold  bath,  preceded  by 
light  calisthenics  or  massage,  is  often  beneficial  in 
hypergesthesic  cases  with  frequent  pollutions.  In  the 
later  periods,  with  anaesthesia  of  the  parts,  cold  sitz 
baths,  cold  sprays  to  the  genitals,  or  cold  shower 
baths,  will  give  good  results. 

Hot  Sitz  Baths  : — In  the  hyperaemic  stage  baths  at 
a  temperature  of  105°  for  ten  minutes  at  bed  time 
are  indicated ;  after  the  bath  the  part  should  be  care- 
fully dried  with  a  soft  towel,  avoiding  all  friction. 

Steel  Sounds: — If  there  is  much  prostatic  irrita- 
bility the  passage  of  a  full-sized  steel  sound  every 
third  day  or  once  a  week  is  of  benefit.  It  must  not, 
however,  be  allowed  to  remain  in  the  canal  as  ad- 
vised for  urethral  dilatation,  as  unpleasant  symp- 
toms may  be  caused. 

Stripping  the  Seminal  Vesicles: — This  method  is 
intended  to  reestablish  the  natural  expulsive  power 
of  the  seminal  vesicles  and  ampullae  by  the  removal 
of  inflammatory  deposits.  Fuller,  who  originated 
this  plan  of  treatment,  described  it  as  folloAvs :  "  The 
patient,  whose  bladder  must  be  full,  is  directed,  while 
standing  with  the  knees  straight,  to  bend  the  body 
forward  at  right  angles;  the  operator  now  intro- 
duces the  forefinger  of  one  hand  into  the  rectum, 
while  v^ith  the  other  firm  counter  pressure  is  made 
over  the  pubes.  The  end  of  the  forefinger  w^ill,  in  all 
ordinary  cases,  reach  beyond  the  posterior  margin  of 
the  prostate,  and  the  bodies  of  the  vesicles  can  be  de- 
tected, one  on  each  side  of  the  posterior  border  of  the 


560  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

gland.  Only  the  lower  half"  can  be  felt  in  ordinary  in- 
stances. Firm  pressure  is  made  by  the  tip  of  the 
index  finger,  reaching  as  far  back  as  possible.  The 
finger  tip  should  be  slowh'-  and  firmh'  drawn  along 
the  line  of  the  vesicle,  the  manoeuvre  being  aided  at 
the  same  time  by  counter-pressure  over  the  pubes. 
The  procedure  may  be  performed  several  times  on 
each  vesicle.  In  this  manner  if  the  sac  is  distended 
some  of  the  contents  can  be  pressed  into  the  pros- 
tatic sinus.  After  the  manipulation,  the  urine  should 
be  voided  in  order  to  ascertain  how  much  has  been 
expressed.  This  treatment  should  not  be  repeated 
more  frequentlj^  than  once  in  four  days.  If  applied 
too  often,  or  with  too  firm  pressure,  active  symp- 
toms may  be  induced,  even  causing  acute  epididy- 
mitis. (Ful.)  The  finger  of  the  operator  should  be 
protected  by  a  rubber  tip.  Evidence  of  inflamma- 
tion, the  presence  of  pus  in  the  urine  voided  after 
manipulation  or  increase  of  tenderness  are  contra- 
indications. 

Rectal  Psychophore: — Excellent  results  are  ob- 
tained in  the  same  class  of  cases  that  call  for  the  pre- 
ceding method.  Ice  water,  or  alternating  hot  and 
cold  water,  should  be  used  by  means  of  Carleton's 
psychophore.  The  psychophore,  alternated  every 
fifth  day  with  Fuller's  method,  will  give  very  satis- 
factory results. 

Intra- Vesical  Douches: — These  are  indicated  for 
hyperaemia  or  catarrh  of  the  posterior  urethra  or 
when  the  bladder  is  involved  to  any  extent.  Valen- 
tine's modification  of  Janet's  method  may  be  used,  or 
preferably  a  No.  12  F.  catheter,  sterilized,  may  be 
introduced  into  the  bladder  after  the  urine  is  evacu- 
ated, and  4  to  6  ounces  of  an  antiseptic  fluid  injected 


SPERMATORRHCEA.  561 

with  Janet's  antiseptic  sj^ringe.  As  soon  as  there  is 
a  sensation  of  fullness  the  catheter  should  be  with- 
drawn and  the  bladder  emptied.  The  antiseptic  solu- 
tions which  act  favorably,  are  Formalin,  1-1000- 
10,000;  Bichloride  of  Mercury,  1-12,000-20,000; 
Nitrate  of  Silver,  1-2000-8000;  Potass.  Permang., 
1-2000-10,000.  Bladder  irrigations  should  be  ad- 
ministered after  manipulations  of  the  ampuUee,  never 
before. 

Deep  Urethral  Douches: — Are  of  service  for  pos- 
terior urethral  irritation.  Janet's  antiseptic  vesical 
syringe,  or  an  ordinary  fountain  syringe,  attached  to 
a  catheter,  may  be  used,  injecting  from  a  few  ounces 
to  a  pint  of  the  selected  solution  every  one  to  four 
days. 

The  solutions  for  this  purpose  are : 

Nitrate  of  Silver,  1-500-1000. 

Formalin,  1-1000. 

Thalline  Sulphate,  1-40-100. 

Iodoform  Emulsion,  5  per  cent. 

Instillations: — Often  of  advantage;  they  sometimes 
act  best  when  the  applications  are  made  through  a 
soft  rubber  catheter,  cut  to  8^  inches  in  length,  so 
that  the  eye  of  the  catheter  when  fully  introduced 
will  be  located  in  the  centre  of  the  prostatic  urethra ; 
then  with  a  Taylor's  minim  syringe  from  10  minims 
to  a  drachm  of  the  selected  solution  can  be  intro- 
duced without  pain  or  injury.  The  action  of  the 
compressor  urethra  muscle  will  prevent  the  flow  of 
the  solution  from  and  into  the  urethra  and  tend  to 
cause  it  to  pass  backward  into  the  bladder.  The 
Keyes-Ultzmann  sj^ringe  should  be  emplo^i-ed  for 
stronger  instillations.  The  bladder  should  be  quite 
full  at  the  time  in  order  to  subsequently  dilute  the 
37 


562  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

solution  by  the  passage  of  the  urine  through  the 
urethra. 

The  following  strong  solutions  are  recommended : 
Nitrate  of  Silver,  1  to  10  per  cent.;  Sulphate  of  Cop- 
per, 10  per  cent.;  Tr.  Iodine,  Carbolic  Acid,  Borogly- 
ceride,  equal  parts. 

When  these  are  employed  commence  with  one  of 
one-tenth  the  strength  of  that  which  it  is  intended  to 
finally  administer ;  at  the  first  application  apply  10 
minims  and  gradually  increase  the  strength  at  each 
sitting,  repeating  the  application  eyerj  fourth  day 
until  the  desired  strength  or  satisfactory  results 
have  been  obtained. 

In  making  instillations  of  weak  solutions  the  blad- 
der should  be  emptied  and  the  solution  placed  in  the 
posterior  portion  of  the  urethra,  allowed  to  flo-w 
back  into  the  bladder  and  then  voided,  thus  afford- 
ing a  double  application.  The  w^eaker  solution  for 
instillations  are  those  which  may  be  also  employed 
for  irrigation,  viz.: 

Nitrate  of  Silver,  1-2000-8000. 

Potass.  Permang.,  1-1000-10,000. 

Mercuric  Bichloride,  1-10,000. 

Zinc  Sulpho-Carbolate,  1-1000-3000. 

Carbolic  Acid,  1-100-500. 

If  urethral  instillations  cause  too  much  reaction 
they  must  be  reduced  in  strength,  preceded  by  Co- 
caine, or  discontinued.  When  nitrate  of  silver  solu- 
tions cause  pain  it  may  be  relieved  by  douches  of 
sodium  chloride. 

Urethral  Psychophore : — With  water  at  40°  to 
50°,  may  be  applied  for  five  or  ten  minutes  everyday, 
or  ever3^  third  day.  This  is  indicated  w^hen  there 
is  hyper^esthesia  of  the  posterior  urethra,  with  or 


SPERMATORRHCEA.  563 

without  impotence,  especially  when  the  urethral  dis- 
charge is  free  from  pus.  When  there  is  anaesthesia 
and  loss  of  tone  hot  w^ater  at  a  temperature  of  105° 
to  110°  ma3'  be  employed  with  good  effect.  A  psy- 
chophore  of  sufficient  size  to  fill  the  urethra  should 
be  used  and  placed  in  such  a  position  that  its  three 
distal  inches  come  in  exact  relation  with  the  local 
lesion,  the  remainder  of  the  instrument  not  trans- 
mitting either  heat  or  cold. 

Dilatation  of  the  Prostatic  Urethra: — Diseased  con- 
ditions in  this  part  may  necessitate  this  procedure  in 
order  to  empty  the  follicles  of  the  prostate.  A  pros- 
tatic dilator  should  be  used.  Carleton's  instrument 
for  this  purpose  will  afford  very  satisfactory  results. 
When  it  is  desired  to  dilate  the  bulbous  urethra  at 
the  same  time  Kollmann's  antero-posterior  dilators 
"will  answer  well.  Prostatic  dilatations  should  al- 
w^ays  be  preceded  by  urethral  irrigation  and  fol- 
lowed b^^  douching  of  the  bladder.  It  should  not  be 
repeated  more  frequently  than  once  in  ten  days. 

Ichthyol  Suppositories: — Recommended  for  the 
absorption  of  inflammatory  products  in  the  pros- 
tatic and  periprostatic  tissues. 

Electricity : — Faradism  has  good  effects ;  the  brush 
may  be  applied  to  the  genitalia,  or  King's  rectal  elec- 
trode maj^  be  employed. 

Galvanism  may  be  used  by  applying  the  positive 
pole  to  the  lumbar  or  sacral  region  and  the  negative 
to  the  parts  by  means  of  the  ordinary  electrode  ap- 
plied externally,  or  the  conical  steel  sound.  In  hy- 
perasmic  conditions  of  the  urethra  the  ordinary 
sound  forms  an  excellent  electrode.  A  current  of  one 
or  two  milliamperes  maj^  be  administered  for  not 
longer  than  one  or  two  minutes.    Newman's  sound 


564  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

will  be  required  when  the  general  condition  of  the 
urethra  is  relieved,  but  hyperaesthesic  spots  remain; 
under  these  conditions  three  milliamperes  may  be 
given. 

Outdoor  exercises  and  sports  are  generally  advis- 
able. Bic3^cling,  hoAvever,  should  be  under  medical 
supervision ;  a  properl^^  constructed  saddle,  that  is, 
one  which  does  not  permit  pressure  on  the  perineum, 
is  essential.  Over-fatigue  must  be  avoided  and  the 
erect  posture  maintained  in  riding.  Horseback  rid- 
ing is  not  to  be  permitted.  General  massage  w^ill 
often  be  found  of  benefit. 


SPRAINS. 

Heat  and  Cold: — In  regard  to  the  use  of  these 
agents,  in  which  there  appears  to  be  some  diversity 
of  opinion,  the  following  indications  are  given  by 
Mr.  Tubby  (Practitioner,  April,  1897) : 

If  the  injury  is  seen  w^ithin  the  first  two  or  three 
hours  apply  cold  vigorously  by  pouring  on  cold 
w^ater  or  by  the  use  of  ice  or  spirit  lotions ;  this 
should  be  kept  up  for  ten  or  fifteen  minutes ;  then 
wrap  the  limb  in  lint  soaked  in  cold  water  or  spirit 
lotion,  place  it  in  a  proper  position  and  firmly  band- 
age. If  seen  later  hot  applications  should  be  fre- 
quently made,  either  hot  water  or  hot  vinegar  and 
salt.  Keep  the  joint  at  rest  and  maintain  steady 
pressure  with  bandages.  Before  this,  especially  if 
there  is  much  swelling,  use  friction,  the  object  of 
w^hich  is  to  empty  the  lymphatics  of  a  certain 
amount  of  coagulated  lymph.  In  rubbing  it  is  al- 
w^ays  advisable  to  commence  at  the  part  most  dis- 


SPRAINS.  565 

tant  from  the  joint,  thus  emptying  the  lymphatics 
in  that  locaHty  first.  Not  a  few  writers  advocate  the 
immediate  use  of  hot  appHcations  as  soon  as  the  in- 
jury is  seen. 

Rubber  Bandage  and  Hot  ^Vater: — The  follow^ing 
plan  is  recommended  for  the  relief  of  pain :  Immerse 
the  part  in  hot  water,  increasing  the  temperature 
until  the  patient  becomes  accustomed  to  the  heat 
and  the  pain  becomes  less.  The  next  step  is  the  ap- 
plication of  a  rubber  bandage,  which  is  to  be  applied 
immediately  after  the  discontinuance  of  the  hot 
water.  If  there  is  laceration  of  ligaments,  or  contu- 
sion of  the  parts,  a  wet  compress  may  be  applied, 
over  which  the  bandage  is  placed.  This  may  be  left 
on  for  twenty-four  hours.  In  injuries  of  the  knee  it 
may  be  kept  applied  for  several  days.  It  should  be 
put  on  hot  and  changed  several  times  a  day.  If  the 
skin  becomes  thickened  or  white  as  from  a  poultice 
omit  the  compress.  The  bandage,  however,  must  be 
worn  constantly,  and  the  compress  reapplied  should 
pain  follow  its  removal.     (Hel.) 

Aspiration: — In  severe  injuries  when  there  is  much 
enlargement,  and  a  great  amount  of  blood  has 
poured  into  the  joint;  it  should  be  removed  v^ith  the 
aspirating  needle  under  careful  antisepsis.     (A.) 

Strapping  — The  method  of  Gibney  and  Cotterell  is 
recommended  both  in  early  and  late  stages,  viz.: 

For  sprain  of  tarsus  and  ankle,  take  strips  of 
plaster  one  and  a  half  inches  wide,  and  eighteen 
long;  the  first  strip  starts  at  the  juncture  of  the 
middle  and  upper  third  of  the  leg,  outer  or  inner 
side;  apply  close  to  the  tend o- Achilles,  carrying  it 
across  the  sole  of  the  foot  to  the  base  of  the  great 
or  little  toe ;    several  strips  are  applied,  covering  the 


566  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

inner  or  outer  side  of  the  ankle.  A  strip  is  then  ap- 
plied with  its  middle  at  the  point  of  the  heel.  The 
ends  come  to  a  point  on  the  foot  at  the  junction  of 
the  metatarsal  bone  and  tarsus.  A  number  of  these 
ascending  strips  are  applied  in  an  imbricating  manner 
until  the  entire  joint  is  covered.  These  strips  should 
be  applied  so  as  to  meet  in  front  of  the  ankle  and 
make  circular  constriction.  After  strapping  apply  a 
bandage,  and  the  patient  is  allowed  to  walk.  ( W.  C.) 
This  method  is  now  much  used,  being  highly  en- 
dorsed. 

Splints  and  Plaster  of  Paris : — In  severe  sprains  re- 
duce misplaced  tendons,  apply  hot  or  cold  water, 
and  later  apply  splints  or  plaster  of  Paris  as  in  frac- 
tures. After  wearing  these  for  a  time  they  should  be 
removed  and  massage  employed.     (W.  C.) 

Bandaging : — Should  be  used  in  all  forms  unless 
plaster  or  splints  are  employed.  Usually  sufficient 
in  mild  cases  after  applying  compresses  or  lotions. 
(W.  C.) 

Compression:  —  Wrapping  the  joint  in  plenty  of 
cotton  and  bandaging  somewhat  firmly,  will  often 
prove  effective.     (A.) 

Arnica: — Verj^  useful ;  the  tincture  of  the  root  is  to 
be  preferred,  1  part  to  about  5  of  water;  apply  with 
compress  and  bandage. 

Lead  and  Opium  "Wash: — A  remedy  of  great  effi- 
cacy.   The  formula  is  as  follow^s : 

5fc.    Tinct.  Opii, 

Liq.  Plumbi  Subacetat.  Dil.,  aa  gij. 

Aquffi,  q.  s.  ad  Oj. 

M. 

Sig.     Saturate  a  compress,  squeeze  out  excess,  and  apply  over 
all  a  roller  bandage. 


SPRAINS.  567 

Massage: — Excellent  results  have  been  obtained  in 
all  forms  of  sprains  and  contusions,  and  in  the  in- 
juries of  the  soft  parts  consequent  upon  dislocations. 
Applications  may  be  made  immediately  or  very  soon 
after  the  injury.  Dr.  J.  Robie  Wood  recommends 
that  in  sprains  of  the  ankle  the  part  be  placed  in  hot 
Avater,  and  at  the  same  time  massed  with  an  up- 
ward movement ;  then  adhesive  strips,  according  to 
the  method  of  Gibney  and  Cotterell,  are  to  be  ap- 
plied. Massage  is  also  of  great  efficacy  after  the 
subsidence  of  acute  symptoms,  when  much  stiffness, 
pain  and  loss  of  power  remain,  constituting  in 
this  condition  the  most  important  measure  for  the 
restoration  of  the  limb. 

Ammonia: — The  following  combinations  form  use- 
ful liniments : 

1^.    Aq.  Ammonise, 

Fid.  Ext.  Amicse, 

Lin.  Saponis, 

Ol.  Terebinthinae,  aa  5^]- 

M. 
Sig.     Rub  in  several  times  a  day. 

P;.    Lin.  Ammoniae,  ^i]. 

Spts.  Chloroformi,  gj- 

Lin.  Mentholi,  ^ij. 

Tr.  Opii,  Sj. 

M. 

Sig.     Rnb  well  over  the  surface.  (Sm. ) 

Hamamelis: — The  aqueous  extract,  somewhat  di- 
luted with  water,  forms  a  most  useful  remedy ;  apply 
with  compresses,  and  cover  with  rubber  protectors. 

Ichthyol:  —  Applied  with  friction  and  massage  is 
said  to  sometimes  give  satisfactory  results.     (Sm.) 

Alcohol: — Equal  parts  with  water,  forms  a  useftil 
evaporating  lotion.     (N.) 


568  DIGEST  OF  EXTERNAI.  THERAPEUTICS. 

Tr.  Rhus  Tox.  or  Tr.  Rutta,  diluted,  may  be  used 
with  good  effect  after  hot  water  applications.  (Rd.) 
The  various  liniments,  viz.:  Aconite,  Belladonna, 
Camphor,  Chloroform,  Soap,  and  Turpentine  are  all 
of  use. 


STRANGURY. 

Electro-Static  Current  to  the  spine  and  hypogas- 
trium  has  been  very  effective.  W^arm  Sitz  Baths, 
Hot  Fomentations  to  the  perineum.  Suppositories 
containing  Opium,  Belladonna  or  Hyoscyamus.  (CI.) 


STRICTURE,  SPASMODIC. 

Hot  Sitz  Baths  and  Hot  Fomentations,  if  not  re- 
lieved, use  the  Catheter.  When  this  is  not  possible, 
ansesthetize  and  use  catheter,  or  Aspirate  to  give  im- 
mediate relief,  assuring  the  patient  that  the  next 
urination  will  be  normal.  (CI.)  Morphia,  hypo- 
dermically,  may  be  necessary. 


STOMATITIS. 

The  treatment  of  the  different  varieties  of  this  dis- 
ease resemble  each  other  so  closely  that  they  will  be 
considered  collectively.  Particular  attention  should 
be  directed  toward  securing  an  aseptic  condition  of 
all  w^hich  comes  in  contact  with  the  mucous  mem- 


STOMATITIS.  569 

brane  of  the  mouth.  Every  means  should  be  em- 
ployed to  prevent  infection.  Nurses  should  exercise 
care  in  cleansing  the  infant's  mouth,  and  avoid 
w^ounding  the  mucous  membrane.  In  health  anti- 
septic mouth  vyrashes  are  not  necessary,  but  steril- 
ized w^ater  should  be  used  for  cleansing.  Gentle  fric- 
tion w^ith  a  soft  cloth  is  advised  in  thrush  for  the 
removal  of  the  exudate  in  order  to  permit  of  the 
more  perfect  action  of  local  remedies ;  alkaline  solu- 
tions effect  this  purpose  also.     (Gn.) 

Boric  Acid  or  Borax: — 1  to  3  per  cent.,  or  stronger 
solutions,  constitute  the  most  frequently  employed 
and  generally  effective  remedies  in  cases  of  the  ca- 
tarrhal, aphthous,  and  membranous  (Thrush) 
variety.  (Hit.)  Borax  vvrith  honey  or  glycerine  is 
used.     (Rd.) 

Potass.  Chlorate: — 3J,  to  water,  §iv,  is  one  of  the 
best  local  remedies  for  general  use.  (B.)  In  the  fol- 
licular and  ulcerous  variety  its  topical  effect  may  be 
obtained  by  giving  it  internally,  and  not  allowing 
the  patient  to  swallow  any  water  for  some  little 
time  after.  The  dose  is  a  drachm  hourlj^  of  a  solu- 
tion of  8  grains  to  5  ounces  of  glvcerine  and  water. 
Qac.) 

Nitrate  of  Silver : — 1-1000  or  500,  may  be  brushed 
on  in  the  catarrhal  forms  when  the  tongue  and 
mucous  membrane  are  dry.  In  the  aphthous  va- 
riety, when  there  is  a  tendency  to  superficial  ulcera- 
tion, a  solution  of  1-50  may  be  applied  gently. 
Weaker  solutions,  as  1-500,  applied  daily  are  ser- 
viceable in  Bednar's  aphthae  and  thrush.     (Jac.) 

Potass.  Permang.: — When  a  stronger  disinfectant 
is  required,  solutions  of  1-250  or  500  four  or  five 
applications  daily.     (Jac.) 


570  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Alum : — Local  applications  of  solutions  constitute 
one  of  the  most  reliable  remedies  in  relaxed  condi- 
tions of  the  mucous  membrane.  The  use  should  not 
be  prolonged  on  account  of  destructive  action  on 
teeth.  (Al.)  The  powders  or  a  solution  3ss,  water, 
^,  are  used.     (Ty.) 

Sulphurous  Acid: — Strong  or  diluted,  as  a  spray. 

Bismuth  Subnitrate : — As  a  dusting  powder  di- 
rectly to  the  ulcers,  or  5J  to  gl3^cerine  5j- 

Tr.  Hydrastis: — ^ij,  gh^cerine  gij. 

Carbolic  Acid: — 1  per  cent,  solution,  as  a  mouth 
wash,  or  the  pure  acid  to  ulcers  as  an  anaesthetic  and 
cauterant. 

Naphthalin: — 5  to  10  per  cent,  as  a  dusting  pow- 
der. 

Labarraque's  Solution  in  the  following: 


Liq.  Sodii  Chlorinatae, 

Tinct.  Myrrhae, 

aa  5ss. 

Aq.  Rosae, 

u 

Aq.  Destill., 

Ivj 

M.  (Al.) 

Pyoktanin  Blue:— 1-500. 

Sodium  Salicylate  : — siss,  rose  water  gj. 

Tannin: — Especially  when  the  gums  are  spongy,  5J, 
with  aq.  rosae  gij,  aq.  destill.  5vj. 

Sodium  Sulphite: — 5],  water  §j. 

Tr.  Iron  and  Glycerine: — Equal  parts,  painted  on 
ulcerations  forms  a  good  application. 

Myrrh: — 5J,  water  gvj,  a  little  boric  acid,  borax,  or 
a  few  drops  of  carbolic  acid  or  thymol  may  be  added 
■w^ith  good  effect. 

Lemon  Juice: — Properly  diluted,  forms  an  agree- 
able mouth  wash. 

Resorcin: — As  a  dusting  powder. 


SUNSTROKE.  571 

Copper  Sulphate: — Gr.  x,  water  ^j  in  chronic  re- 
current forms ;  the  ulcers  may  be  touched  with  the 
pure  crystals. 

Hydrochloric  Acid: — Gtt.  v.,  glycerine  ^ss. 

Baptisia: — The  decoction  as  a  mouth  wash. 

MERCURIAL  STOMATITIS. 

The  local  treatment  of  this  condition  does  not  ma- 
terially differ  from  that  of  other  forms.  The  reader 
is,  therefore,  referred  to  the  previous  article.  The 
remedies  to  which  preference  should  be  given  are 
Chlorate  of  Potassium,  Alum,  Myrrh,  Tannin  and 
Labarraque's  Solution. 


SUNSTROKE— PROSTRATION  BY 
HEAT. 

Cold  Baths  and  Affusions: — Severe  cases  with  high 
temperature  should  be  treated  with  ice  baths,  plac- 
ing the  patient  in  a  tub  of  water  w^ith  ice  floating  in 
it,  the  bath  being  at  a  temperature  of  about  44°. 
When  baths  are  not  convenient  or  deemed  expedient, 
strip  the  patient,  place  ice  on  his  head,  and  pour  cold 
water  over  body.  Care  should  be  taken  not  to  re- 
duce temperature  too  fast  or  too  low^ ;  a  temperature 
of  102°  should  be  a  signal  for  the  withdrawal  of 
cold.  After  the  bath  or  cold  affusion  the  patient 
should  be  dried,  removed  to  a  cot,  an  ice  cap  placed 
on  the  head  and  the  body  lightly  covered.  He  should 
be  allowed  to  rest  until  exacerbation  indicates  the 
need  for  a  renewal  of  cold  applications.     (An.) 


572  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Cold  ^Al^ate^  Enteroclysis: — Useful  in  extreme  cases 
when  temperature  remains  very  high;  administer 
about  2  quarts  as  often  as  required.     (Sj.) 

Quinine: — It  is  claimed  by  physicians  residing  in 
the  East  Indies  that  the  mortality  from  heat  apo- 
plexy has  been  reduced  more  than  50  per  cent,  by  the 
administration  of  this  remedy.  The  sulphate  may 
be  given  hypodermically  in  several  injections  of  IV^ 
grains  each.  (N.)  A  formula  for  hypodermic  use  is 
as  follows : 

^.    Quin.  Sulphatis,  9iv. 

Acid.  Sulphuric.  Dilut.,  3"ss. 

Acid.  Carbolici  Pur.,  gr.  ij. 

Aq.  Destill.,  q.  s.  ad  ,^j. 
M. 
Sig.     Dose  M.  x-xxx=gr.  iij-x. 

Another  form  for  hypodermic  injection  is  the 
double  salt  of  quinine  and  urea,  Quiniae  Hydro- 
chloras  Carbamidata,  a  formula  for  which  for  sub- 
cutaneous administration  is  as  follows : 

5fc.    Quin.  Hydrochlorat.  Carbamidatse,  S^j- 

Div.  in  chart.  No.  xxiv. 

Sig.     Dose  I  or  2  powders^gr.  v-x  in  30  minims  of  distilled 
water.     (Sm.) 

Counter- Irritation: — To  the  nape  of  the  neck  w^hen 
there  is  evidence  of  meningeal  irritability.     (Sj.) 

Morphia: — Subcutaneously,  is  of  benefit  in  cases 
characterized  by  pallor  of  the  face  and  weakness  of 
the  heart,  that  is,  heat  exhaustion.     (B.) 

Ether  first,  then  CafTein,  hypodermically,  for  col- 
lapse.    (Sj.) 

Venesection : — May  be  indicated  in  apoplectical 
cases.    (An.) 


SYCOSIS  COCCOGENICA.  573 

Hot  Baths: — If  after  reduction  of  the  fever  diapho- 
resis does  not  occur  a  bath  msLj  be  administered,  and 
possibly  a  hvpodermic  of  Pilocarpine  in  urgent  cases. 
(An.) 

Artificial  Respiration: — Should  be  employed  when 
there  is  collapse,  and  kept  up  until  other  measures 
have  had  time  to  act.     (An.) 


SYCOSIS  COCCOGENICA. 

Treatment  will  vary  according  to  the  stage  of  the 
disease.  When  acute,  emollient  and  soothing  appli- 
cations will  be  indicated,  together  with  cutting  the 
hair  as  short  as  possible  and  the  removal  of  scales 
and  crusts  hj  means  of  oils  and  fomentations. 

Ammoniated  Mercury: — When  papules  are  begin- 
ning to  appear  2  parts  of  the  ointment  with  1  of 
vaseline  are  sometimes  effective  in  arresting  the 
progress  of  the  disease.     (Ck.) 

Shaving : — There  is  some  divergence  of  opinion  in 
regard  to  the  utility  of  this  measure ;  some  writers, 
while  admitting  that  it  enables  the  remedy  to  reach 
the  skin  with  greater  ease,  claim  that  it  tends  to 
spread  the  infection ;  it  is  moreover  painful  to  many. 
On  the  other  hand,  some  dermatologists  insist  that 
it  is  essential  to  successful  treatment,  advising  it 
every  second  or  third  day.  When  done  for  the  first 
time,  the  hair  should  be  clipped  close  and  a  poultice 
applied  to  soften  the  crusts.  The  lather  from  a  car- 
bolic shaving  stick  applied  and  left  on  skin  over 
night,  is,  according  to  Crocker,  a  useful  adjunct. 

Poultices: — If  there  is  much  oedema  and  severe  in- 


574  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

flamtnation,  warm  fomentations  -will  prove  of  bene- 
fit; in  some  cases,  hoA^'-ever,  cold  starch  poultices 
give  better  results.  Qa.)  A  poultice  made  with 
bread  and  dilute  lead  water,  applied  cold,  is  recom- 
mended in  preparing  the  face  for  shaving. 

Epilation: — When  there  are  pustulations  and  the 
beard  can  not  be  shaved,  each  affected  hair  must  be 
pulled  out  and  the  follicles  cleansed  with  a  weak 
antiseptic  lotion,  and  an  ointment  of  resorcin  or 
sublimate  applied.  This  measure  should  only  be  used 
w^hen  the  roots  of  the  hair  are  loosened.     (Ck.) 

LiOtio  Nigra: — Of  service  when  the  disease  is  acute, 
and  there  is  much  pain  and  swelling.  It  may  be  ap- 
plied everj'  two  or  three  hours,  followed  each  time 
by  Oxide  of  Zinc  Ointment,  applied  by  means  of  the 
finger,  or  spread  upon  pieces  of  linen,  and  bound 
upon  the  parts.     (Sh.) 

Bichloride  of  Mercury: — A  lotion  of  2  grains  to 
the  ounce  of  water  after  epilation.     (Rd.) 

Lead  Water  and  Laudanum,  weak  solutions  of 
\A^itch  Hazel,  Zinc,  and  Lead  Acetate  form  useful, 
sedative  and  astringent  lotions  for  the  reduction  of 
swelling  and  inflammation.     (Sh.) 

The  following  wash  is  also  of  service  in  the  acute 
stage : 

5fc.    Pulv.  Zinc.  Carb.  Paecipitati, 

Pulv.  Zinc.  Oxidi, 

Glycerini, 

Liq.  Plumbi  Subacetat.  Dil.,  aa  sjij. 

Aq.  Rosae,  ^viiss. 

M.  (Vn.) 

Oils: — When  there  is  a  good  deal  of  crusting,  these 
preparations  are  indicated,  viz.:  Oil  of  Ergot,  Olive 
Oil  with  fluid  Mercury  Oleate,  or  Cod  Liver  Oil  alone 


SYCOSIS  COCCOGENICA.  575 

or  combined  with  Arrowroot,  Zinc  or  Lead  Carbon- 
ate, Opium,  Arnica,  or  Belladonna  lightly  penciled 
over  the  surface.     (Sh.) 

Salicylic  Acid: — 2  per  cent,  solutions  in  olive  oil 
excellent  for  softening  the  crusts ;  apply  for  a  day 
and  a  night,  then  wash  with  soap  and  water.  This 
may  also  be  applied  at  night  to  prevent  drying  when 
lotions  are  used  during  the  day.  An  ointment  of  10 
to  15  grains  to  the  ounce  of  Lassar's  paste  forms  a 
stimulating  application  indicated  when  there  is  pus- 
tulation.     (B.  H.) 

Lassar's  Paste,  Zinc  Ointment,  or  Cold  Cream, 
preceded  by  Hot  Water,  sopped  on  for  five  or  ten 
minutes  twnce  a  day,  constitute  excellent  soothing 
remedies  for  the  acute  stage,  especially  when  the  face 
is  shaved.  The  following  are  also  useful  applica- 
tions after  shaving : 

^.    Zinc.  Oxidi, 

Zinc.  Carbonatis,  aa  .^j. 

Ung.  Aq.  Rosae,  ad  ^j. 

M. 

Or, 

J^.    Zinc.  Oxidi,  3J. 

Ol.  Lini,  ^j. 

M.  (Ja.) 

Ointments: — Among  the  most  serviceable  in  earlier 
stages  are :  Zinc,  Lead,  and  Bismuth  Oleates  (alone 
or  combined  w^ith  other  agents)  ;  Calomel,  10 
grains  to  the  ounce  of  cold  cream  or  rose  ointment. 
Resorcin,  Ichthyol,  or  Boric  Acid  may  also  be 
brought  into  requisition.     (Sh.) 

Diachylon  Ointment: — Is  excellent  in  the  acute 
forms  ;  a  few  grains  of  Camphor  may  be  added.  (Sh.) 


576    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

It  may  also  be  advantageously  combined  with  other 
remedies,  as  Oil  of  Cade,  half  a  drachm  to  the  ounce, 
when  the  disease  has  become  chronic  and  requires 
stimulation.     (B.  H.) 

Provan's    Tragacanth     Paste: — Recommended    by 
McCall  Anderson,  is  as  follows : 


^. 

Tragacanthae, 

3SS. 

Glycerini, 

,5ss. 

Sodii  Boratis, 

5ss. 

Aq.  Destill., 

q.  s. 

M. 

^he 

following  combinations 

are  useful : 

5fc. 

Pulv.  Phytolaccae  Rad., 

ij. 

Mentholi, 

gr.  X. 

Ivanolini, 

Ung.  Zinc.  Oxidi, 

aa  ^ss. 

M. 
1«r 

■V    • 

(Sh.) 

Acid.  Carbolici, 

gr.  V. 

Bismuth.  Subnitratis, 

3SS. 

Ung.  Hydrarg.  Ammoniati, 

3ij- 

Ung.  Aq.  Rosse, 

3v. 

M. 

(T.  C,  Vol.  V.) 

Mercurial  Ointments: — Suitable  when  stronger 
preparations  are  demanded.  They  may  be  used 
when  the  eruption  is  confined  to  one  or  two  points, 
and  in  subacute  and  chronic  cases.  Combined,  as  in 
the  following,  w^ith  Sulphur,  they  are  effective: 

5fc.    Hydrarg.  Sulph.  Rub.,  3ss. 

Sulphur.  Sublimati,  §iss. 

Adipis,  ^iv^vss. 
M.  (Ja.) 

Sulphur: — Useful     when     disease     becomes     more 


SYCOSIS  COCCOGENICA.  577 

chronic,  and  inflammation  is  less.  The  following 
v^rash  is  for  subacute  cases,  and  sometimes  succeeds 
-when  other  remedies  fail : 

9=.    Sulphur.  Prsecipitati,  ^ij. 

Pulv.  Campliorge,  gr.  x. 

Pulv.  Tragacanthge,  J^j. 

Aq.  Calcis,  ,^iv. 
M.  (Vn.) 

Pyrogallol : — A  2  per  cent,  solution  in  alcohol 
painted  on  the  affected  part  tv^ice  a  day  and  the  ap- 
plication at  night  of  the  following  ointment  is  rec- 
ommended by  Viell : 

9^.    Sulphur.  Ivactis, 

Alcoholis, 

Aq.  Rosae,  aa   §j. 

Mucil.  Gum.  Acaciae,  M.  xx-xxx. 

M. 

/9-Naphthol: — Kaposi  recommends  the  foUow^ing 
combination  to  which  sulphur  may  be  added  as  fol- 
lows : 

9.    ,?-Naphtholi,  3J. 

Spts.  Sapo.  Viridis,  giij  3j- 

Alcoholis,  gvj  5ij. 

Balsam.  Peruviani,  ^ij. 

Sulphur.  Loti,  ^x. 
M.  (Kap.) 

Green  Soap: — When  the  affection  is  of  long  stand- 
ing, and  there  is  much  infiltration,  a  small  portion, 
rubbed  on  with  a  little  water,  and  then  washed  off, 
followed  by  diachylon  ointment,  is  a  valuable  method 
of  treatment.     (Vn.) 

In  addition  to  the  employment  of  these  remedies, 
it  is  often  of  the  utmost  importance  to  open  the 
various  lesions  that  may  be  present,  and  to  puncture 
38 


578         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

the  surface  thoroughly,  thus  relieving  the  enlarged 
and  congested  blood  vessels,  allowing  stagnated 
blood  to  circulate,  the  effused  serum  to  escape,  and 
preventing  the  formation  of  pus.  If  there  is  much 
thickening  of  skin  depletion  is  followed  by  decidedly 
beneficial  results. 

Massage  and  Static  Electricity: — Serviceably  em- 
ployed when  debility  is  marked.     (Sh.) 

The  rhinitis,  which  is  often  present,  should  be 
treated  with  antiseptic  douches.  After  a  cure  has 
been  effected,  the  patient  should  be  kept  under  obser- 
vation for  some  time.  He  should  be  instructed  to 
bathe  the  face  daily  in  hot  w^ater,  and  apply  some 
protective  ointment.  Ointments,  when  used,  should 
be  bound  on  tightly. 


SYNOVITIS. 

ACUTE  SYNOVITIS. 

Rest  in  the  position  of  greatest  comfort;  Mild  Ex- 
tension ;  Cold  application  by  means  of  Ice  Bags  or 
Leiter's  Coil  (Tre.);  Heat  may  be  substituted  for 
cold  if  the  latter  is  not  agreeable  to  the  patient ;  use 
the  hot  water  bag,  or  immerse  the  parts  in  hot 
water.     (W.) 

The  following  is  an  anodyne  ointment;  apply 
twice  daily  with  a  brush : 

iffc.    Morph.  Sulphatis,  gr.  viij. 

Ung.  Hydrarg.  Oleati,  5  percent.,  5J. 

M. 

Lead  and  Opium  'Wash: — Applied  hot,  forms  one 
of  the  best  applications.     (Tre.) 

Alcohol: — Diluted  with  water,  equal  parts,  forms 
an  excellent  evaporating  lotion. 


SYNOVITIS.  579 

Splints: — To  keep  the  parts  at  rest,  should  be  used 
in  cases  arising  from  traumatism.     (Tre.) 

Aspiration  : — If  there  is  much  tension,  with  ex- 
treme pain,  and  the  capsule  and  ligaments  are  in 
danger  of  being  overstretched,  to  prevent  perma- 
nent damage  the  joint  should  be  aspirated  under 
complete  antisepsis.     (W.) 

Compression: — Equal  pressure  as  firm  as  ca.n  be 
borne,  covering  the  joint  with  cotton  and  bandag- 
ing, is  useful  after  the  more  acute  symptoms  have 
subsided.     (A.) 

Carbolic  Acid: — In  subacute  cases,  v^hen  aspira- 
tion has  failed  to  relieve,  a  permanent  cure  can  ordi- 
narily be  effected  by  injecting  through  a  trocar  2  to 
3  drachms  of  a  5  per  cent,  solution.     (Pk.) 

Hamamelis  or  Vinegar  are  both  useful. 

CHRONIC  SYNOVITIS.   Compare  Chronic  Rheuma- 
tism. 

Rest  of  the  part  is  essential. 

Iodine: — The  tincture,  painted  on  the  joint,  has 
long  been  used.  After  its  application  Ashhurst  rec- 
ommended : 

9;.    Ung.  Hydrargyri, 

Ung.  Belladonnse,  aa  ^j. 

M. 

The  following  is  also  for  painting  on  the  part : 

9;.    lodi,  ^ss. 

Potass.  lodidi,  ^j. 

Aquse,  gvj. 
M.  (Sn.) 

Ichthyol: — 20  to  50  per  cent,  in  lanolin,  rubbed  on 

the  joint,  which  is  bound  in  cloths  covered  with  the 

same  ointment,   is  sometimes  attended  v^ith  good 

results.     (M.  H.) 


580  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Mercurial  Ointment: — Was  used  by  Dupuytren  in 
the  form  of  inuntions,  viz.: 

9;.    Ung.  Hydrargyri,  gij. 

Pulv.  Ainmon.  Chloridi,  3j. 

M.  (Sn.) 

Carbolic  Acid: — An  injection  of  10  minims  of  a  so- 
lution of  gr.  viij,  distilled  water  §j,  is  used,  repeating 
every  third  day.     (Sn.) 

Pressure  by  an  Elastic  Bandage,  Friction,  Mass- 
age, are  all  of  service.     (Pk.) 

Aspiration  and  Irrigation  of  the  Capsule  and  Joint: 
— Are  most  effectual  methods.  Strict  antisepsis 
should  be  followed,  shave  the  joint  and  w^ash  it 
thoroughly'  with  ether,  then  sublimate  1—3000,  and 
apply  an  antiseptic  rubber  bandage  around  the 
parts,  leaving  a  small  space  exposed  for  the  insertion 
of  the  needle.  An  aspirator  should  be  used  for  the 
withdrawal  of  the  fluid,  after  which  the  capsule 
should  be  filled  to  distension  with  a  sublimate  solu- 
tion of  1-10,000 ;  then  the  same  is  withdrawn,  and 
an  antiseptic  dressing  applied,  followed  by  plaster  of 
Paris  splints  or  some  fixed  apparatus.     (W.) 

Opening  the -joint  and  removal  of  hypertrophied 
tissue  is  folio w^ed  by  excellent  results.     (Tre.) 


SYPHILIS. 

Mercury: — The  methods  of  administration  other 
than  bj'  the  mouth  of  the  cardinal  remedy  for  this 
disease  are  by  Inunction,  Subcutaneous  Injection, 
Fumigation,  and  Calomel  in  Traumaticin. 


SYPHILIS.  581 

Inunction : — This  should  be  restricted  to  those 
cases  where  there  is  faulty  digestion,  such  as  catar- 
rhal conditions  of  any  part  of  the  alimentary  canal, 
where  the  internal  administration  of  the  mercurial 
preparations  has  not  been  attended  with  results, 
and  where  the  conditions  demand  immediate  and 
direct  action ;  in  the  latter  instance  it  wnll  be  found 
invaluable. 

Ung.  Hydrargyri: — The  ordinary  ointment  of  the  U. 
S.  P.  is  genenerally  used.  It  is  very  important  that  it 
should  be  freshly  prepared ;  about  40  grains  consti- 
tute the  dose  for  one  application.  The  body  is 
usually  anointed  at  six  sittings,  as  follows:  The 
back  and  neck,  chest  and  abdomen,  right  arm  and 
left  arm,  right  leg  and  left  leg,  avoiding  the  scrotum. 
Hairy  parts  should  be  avoided.  If  it  is  not  possible, 
they  should  be  shaved.  Should  that  be  objectionable 
the  Ung.  Hydrarg.  Ammoniati  may  be  substituted. 
The  inunctions  are  best  administered  by  a  profes- 
sional masseur.  The  region  should  be  first  washed 
with  soap  and  carbolized  water.     (CI.) 

Between  the  first  and  second  applications  there 
should  be  an  interval  of  about  five  days  or  less ;  be- 
tween the  second  and  third,  five  to  ten  days ;  between 
the  others,  about  two  weeks.  Hot  baths  should  be 
given  during  these  intervals.  This  method  of  admin- 
istering mercurA'  is  not  always  well  borne ;  some  are 
easily  salivated,  while  others  may  suffer  from  eczema 
and  erythema.  Patient  should  be  carefully  watched 
to  see  if  any  untoward  effects  are  produced  requiring 
a  decrease  of  dose  or  discontinuance.     (CI.) 

A  20  per  cent,  ointment  of  the  Oleate  of  Mercury 
may  be  used  ;  it  has  the  advantage  of  being  less  dis- 
agreeable than  the  ordinary  mercurial  ointment,  but 


582  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

being  more  easily  absorbed  it  should  be  applied  with 
a  brush  and  not  rubbed  in,  at  least  no  so  vigorously. 
(N.) 

Hyrgolum: — This  preparation  of  mercury  finds  its 
most  important  use  as  an  inunction  in  syphilis.  It  is 
a  quicksilver  in  a  new  allotropic  form.  The  ordinary 
form  is  that  of  a  fluid  metal  entirely  insoluble  in 
w^ater.  Hyrgolum,  on  the  other  hand,  has  the  follow- 
ing properties :  It  is  a  solid  body  of  a  dark,  almost 
black  color,  fairly  soluble  in  cold  water  and  insoluble 
in  alcohol  and  ether.  As  now  prepared  for  the  market, 
there  remains  a  small  insoluble  residue.  The  aqueous 
solution  is  neutral  and  entireh'  free  from  all  caustic 
properties.  It  is  dark  in  color,  transparent  to  trans- 
mitted light,  but  strongly  fluorescent  and  hence 
opaque  to  incident  light.  The  advantages  claimed 
for  it  over  blue  ointment  are  its  freedom  from  un- 
pleasant effects,  stomatitis  being  very  rare;  the 
clothing  is  not  soiled  and  the  skin  is  free  from  irrita- 
tion. The  technique  of  application  is  also  easier. 
Six  inunctions  a  week  in  the  usual  locations  are 
used.  The  quantity  for  a  single  application  varies 
with  the  susceptibilty  of  the  patient  and  intensity  of 
the  symptoms.  The  average  dose  for  an  adult  is  30 
grains.  In  most  instances  it  is  not  necessary  to  ex- 
ceed this.  Severe  eases  may  require  45  to  60  grains. 
In  w^eak  or  anaemic  patients  and  those  in  whom 
there  is  an  idosyncrasy  for  mercury',  the  dose  should 
be  15  grains  daily  or  every  other  day.  The  following 
is  a  suitable  formula  for  composing  an  ointment  for 
inunction : 


SYPHILIS.  583 

9;.    Hydrarg.  Colloidalis,  lo  grams. 

Aq.  Destill.,  lo  grams. 

Adipis  Suilli,  80  grams,  ^  ^^  ^^^^^ 

Cerse  Albse,  20  grams,  i 

Ether.  Sulphurici,  1.5  grams. 

Ether.  Benzoatis,  3.5  grams. 

M.  Ft.  Ung. 
The  colloidal  mercury  should  be  dissolved  in  an  abundance  of 
cold  distilled  water  before  incorporation,  since  a  too  \'igorous  rub- 
bing of  the  substance  with  the  menstruum  changes  it  into  in- 
soluble mercury  of  the  ordinary  form.  The  aqueous  solution  is 
then  added  in  small  quantities  at  a  time  to  the  lard  and  wax,  with 
constant  stirring,  until  the  salve  has  an  even  greyish-black  color. 
The  ethers  are  then  added;  these  are  of  the  greatest  importance  in 
facilitating  the  intimate  mixture  of  the  fats  with  the  colloidal 
mercury,  in  favoring  the  stability  of  the  salve  and  its  absorption 
by  the  skin,  and,  finally,  in  improving  the  odor  of  the  preparation. 

The  average  time  required  for  application  is  about 
eight  and  a  half  minutes.  No  especial  exertion  is 
necessary  and  w^hen  the  inunction  is  finished  the  skin 
resumes  its  normal  color.  No  black  material  comes 
off  afterwards  as  with  the  use  of  blue  ointment.  A 
slight  redness  occurs  which  soon  disappears.  (B.  K. 
W.,  98,  No.  42.) 

Subcutaneous  Injection: — There  a  is  divergence  of 
opinion  among  writers  in  regard  to  the  advantage 
of  the  hypodermic  administration  of  mercury.  Ac- 
cording to  Martineau,  its  action  is  more  rapid,  more 
effective,  and  more  energetic  than  by  any  other 
method.  Carleton  recommends  it  as  beneficial  for 
many  cases,  but  not  suitable  for  routine  practice^ 

The  syringe  used  for  mercurial  hypodermic  dosage 
should  have  rubber  mountings ;  both  needles  and  the 
point  of  injection  should  be  rendered  thoroughly 
aseptic.  The  subcutaneous  areolar  tissue  of  the  back 
is  the  best  point  for  injection.     Irritation  may  be 


584         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

caused,  and  in  some  instances,  when  given  improp- 
erly, abscesses  maj^  be  produced.  Of  the  mercurials 
recommended  for  this  form  of  administration  the  fol- 
lowang  have  been  selected  : 

Hydrarg.  Bichlorid.: — A  simple  solution  in  distilled 
wrater,  4  grains  to  the  ounce;  10  minims  daily,  in- 
creased, minim  by  minim,  until  50  have  been  given, 
or  until  the  physiological  effects  have  been  produced. 
The  moment  the  least  mercurial  impression  is  made 
the  dose  must  be  reduced. 

In  place  of  small  doses.  Shoemaker,  of  Philadel- 
phia, has  used  injections  of  ^  to  %  grain  in  the 
gluteal  region  two  or  three  times  a  week.  This 
method  he  regards  as  especiall3^  adapted  to  subjects 
with  broken-down  constitutions,  where  it  affords 
the  most  positive  way  of  limiting  or  curing  the  dis- 
ease in  long  standing  cases. 

The  following  solution  is  also  employed : 

9^.    Hydrarg.  Bichlorid.,  gr.  -sv. 

Sodii  Chloridi,  ^ss. 

Aq.  Destill.,  ^iij. 

M. 
Sig.     Inject  x  to  xv  minims  every  second  day.    (Sm.) 

Albuminate  of  Mercury:  —  Prepare  as  follow^s: 
Corrosive  sublimate  15  grains,  distilled  water  5 
drachms ;  to  this  solution  add  5  drachms  of  white  of 
egg,  shake  thoroughly,  and  incorporate  ^  drachm 
of  sodium  chloride  and  2  ounces  of  distilled  w^ater. 
This  mixture  is  again  w^ell  shaken,  then  filtered  and 
sufficient  w^ater  added  to  make  4  ounces.  The  dose 
is  15  to  30  minims.     (B.) 

Amidopropionate  or  Alaninate  of  Mercury: — An 
eligible  mercurial  for  subcutaneous  use,  as  it  does 
not  cause  irritation  at  the  site  of  injection.  The  dose 
in  syphilis  is  yV  to  \  grains  daily.     (F.) 


SYPHILIS.  585 

Asparagin  Hydrargyrate  : — Used  recently  with  ex- 
cellent results  ;  close  ^  grain.     (F.) 

Biniodide  of  Mercury  and  Guaiacol: — It  has  been 
found  that  guaiacol  will  render  painless  intramuscu- 
lar injections  of  gray  oil,  oil  wath  calomel,  and  espe- 
cialW  oily  solutions  of  the  biniodide  of  mercury.  (S. 
M.,  4,  22,  99.) 

The  following  is  a  formula  (Legrange): 

Sterilized  Olive  Oil,  20  drachms. 

Mercury  Biniodide,  6  grains. 

Synthetic  Guaiacol,  36  grains. 

30  minims  of  the  solution  will  represent  }  grain  of 
mercurv"  biniodide.  The  injections  may  be  made  in 
the  thigh.  It  is  a  well  known  fact  the  cocaine  can- 
not be  combined  w^ith  mercurial  preparations  with- 
out the  former  being  precipitated.     (M,  A.,  6,  99.) 

Fumigation: — One  of  the  earliest  methods  of  ad- 
ministration, is  somewhat  less  reliable  than  inunc- 
tions, and  more  easily  productive  of  salivation.  It 
is  useful  in  secondary  and  tertiarj--  cases  v^ith  ulcera- 
tions, when  the  eruptions  are  diffuse,  or  when  the  in- 
ternal administration  of  mercur\^  is  not  v\rell  borne 
or  the  patient  is  unwilling  to  submit  to  inunctions. 
It  is  not  adapted  to  continuous  use. 

Various  mercurials  are  employed,  the  Sulphuret, 
Iodide,  and  Calomel ;  the  latter  is  best,  and  is  gener- 
ally selected.  From  20  to  40  grains  are  put  in  a  cup 
of  water  and  placed  over  a  spirit  lamp,  the  patient  is 
wrapped  in  a  blanket,  and  so  arranged  that  the 
vapor  of  the  mercury  will  fall  upon  the  skin  under 
the  blanket;  or  a  special  apparatus  may  be  em- 
ployed. Commence  with  20  grains  and  gradually  in- 
crease, 5  grains  at  a  time,  administering  every  second 


586  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

day,  watching  the  gums  for  am^  sign  of  sahvation. 
After  the  fumigation,  the  patient  should  retire  to  bed 
to  avoid  taking  cold. 

Never  give  the  fumigations  after  a  meal  or  con- 
tinue their  use  for  more  than  a  month  or  two,     (CI.) 

Calomel  and  Traumaticin : — Favorable  results  have 
been  reported  from  the  following :  A  bath  is  given, 
then  a  25  per  cent,  mixture  of  calomel  and  traumati- 
cin is  painted  on  the  patient's  back,  or  if  there  are 
syphilitic  manifestations  on  the  skin,  it  is  applied 
over  those  surfaces.  This  method  is  peculiarly  well 
adapted  to  cases  when  the  internal  administration 
of  the  drug  is  not  w^ell  tolerated,  and  to  hereditary 
syphilis  in  children.  It  has  the  double  advantage  of 
producing  both  local  and  general  effects  as  well  as 
being  neat  and  cleanly.     (F.) 

SYPHILIS  OF  THE  LARYNX. 

The  local  treatment  of  simple  chronic  laryngitis  is 
generally  applicable  to  this  condition.  In  erythe- 
matous forms  of  inflammation,  if  serious,  the  same 
treatment  as  recommended  for  acute  catarrhal 
laryngitis  should  be  employed.  (L.  B.)  Mucous 
patches  in  the  larj'-nx  do  not  appear  to  have  the 
same  tendency  to  spread  as  when  situated  on  the 
soft  palate  and  pharynx.  If  there  is  any  indication 
for  local  treatment  it  should  be  by  cauterization  in 
the  same  manner  as  for  lesion  w^hen  located  else- 
where. 

Cleansing  sprays  of  Dobell's  Solution  or  Boric 
Acid  are  of  the  first  importance ;  these  should  gener- 
alh^  be  made  daily. 

Iodine  gr.  v,  to  glycerine  or  fluid  cosmoline,  3J,  or 
Zinc  Chloride  in  the  same  proportion ;  the  iodine  is 


SYPHILIS.  587 

useful  when  there  is  increase  of  tissue,  erosion  and 
ulcerations,  otherwise  the  chloride  is  better.  When 
ulceration  is  deep  increase  the  iodine  to  15  grains. 

Guaiac: — Gtt.  j— 5J,  as  a  spray  or  vapor  for  ulcera- 
tion and  oedema.     (Iv.) 

Europhen  and  Iodoform: — Excellent  applications 
for  superficial  ulcerations.     (Bos.) 

Calomel: — By  insufflation,  for  ulceration.     (F.) 

Carbolic  Acid: — Gr.  xx-xl-Oj,  as  an  inhalant  to 
correct  fetor.     (Al.) 

Nitrate  of  Silver: — 3J-5J,  for  superficial  ulceration. 
(Bos.)     As  a  spray,  gr.  v-xxx-^.     (CI.) 

Bichloride  of  Mercury: — Solutions  of  1-1000-500, 
as  a  spra\'  are  employed  in  all  forms  of  deep  ulcera- 
tion and  gummata.     (Bos.) 

Chromic  Acid: — Or.  x-gj.     (Ba.) 

Galvano-Cautery: — The  best  means  for  arresting 
ulcerations  of  the  epiglottis.  (L.  B.)  When  a  thick 
secretion  coats  the  ulcer  it  should  be  removed  with  a 
cotton  covered  prove. 

SYPHILIS  OF  THE  NOSE  AND  NASO-PHARYNX. 

Cleanliness  is  one  of  the  most  important  features 
of  treatment.  Each  time  the  patient  is  seen  the  nose 
should  be  thoroughly  cleansed  w^ith  cotton  pledgets 
under  illumination,  and  at  home  by  the  patient  ^vith 
the  douche  two  or  three  times  daily.  If  the  secre- 
tions are  dry  and  hard,  spraying  the  nasal  chambers 
with  warm  liquid  vaseline  before  employing  the 
cleansing  wash  will  facilitate  removal  of  hardened 
mass. 

The  following  are  suitable  for  cleansing  purposes : 


588  DIGEST  OF  EXTERNAL  THERAPEUTICS. 


9. 

Sod.  Bicarbonatis, 

Sod.  Boratis, 

aa   3j. 

Acid.  Carbolici  (Calvert's  No.  i), 

9j- 

Aq.  Calidae, 

§xx. 

M. 

^. 

Potass.  Chloratis, 
Sod.  Bicarbonatis, 

3SS. 

Sod.  Boratis, 

aa  3j. 

Aq.  Calidae, 

|xx, 

M. 

;Bn.) 

Sodium  Bicarbonate,  Sodium  Borate,  Sodium 
Chloride,  equal  parts,  of  this  about  10  grains  to 
water,  1  ounce;  for  cleansing  in  mild  forms  of 
specific  coryza.  Sodium  Salicylate  (1  per  cent.), 
Acid  Salicylate  (2  per  cent.),  Carbolic  Acid  (1  to  2 
percent.)  are  solutions  useful  when  there  is  much 
discharge  with  tendency  to  decomposition  and  desi- 
cation.  These  may  be  used  in  the  nasal  douche  when 
there  is  ample  room  for  escape ;  otherwise  the  nasal 
bath  may  be  preferred. 

Tar  "Water: — An  excellent  w^ash  for  frequent  use. 
It  is  a  good  deodorizer  and  does  not  disorder  the 
stomach  as  salicylic  acid  and  salicylate  of  soda  may 
do.     (T.,  97.) 

Hydrogen  Peroxide: — Forms  a  valuable  applica- 
tion ;  it  both  cleanses  and  deodorizes  in  a  marked  de- 
gree (Marchand,  15  vol.);  1  part  to  8  of  water.  (Bn.) 

After  cleansing,  a  stronger  detergent  may  be  used, 
such  as  the  following : 

Aluminum  Aceto-Tartrate: — 1  to  2  drachms  of  a 
50  per  cent,  solution  to  a  pint  of  water,  especially 
when  there  is  ulceration  and  fetor.     (T.,  97.) 

Liq.  Potass.  Permang.: — 1  to  4  drachms  to  20 
ounces  of  water. 


SYPHILAS.  589 

Zinc  Sulpho-Carbolate: — A  solution  of  2  grains  to 
the  ounce  of  water. 

The  following  formula  combines  solvent,  stimulat- 
ing and  powerful  disinfecting  qualities : 

Bn.    Potass.  Chloratis, 

Amnion.  Muriatici,  aa.  9j. 

Potass.  Perniang.,  Qss. 

Aq.  Calidae,  ^xx. 

M.  (Bn.) 

Nitrate  of  Silver: — Gr.  v-x-3,  painted  on  (Bn.),  or 
the  fused  drug,  will  cause  large  ulcers  to  heal.    (Ing.) 

Chromic  Acid: — 5  per  cent,  solution,  painted  on 
ulcers  for  stimulation  and  healthy  reaction  in  the 
secondar}^  form.     (Bn.) 

Boric  Acid,  1  part,  w^ith  2  of  lodol  or  Iodoform,  or 
Aristol,  Iodoform,  or  Europhen  for  deep  ulceration 
after  the  sprays.  Fine  Powdered  Camphor  will  serve 
as  a  deodorant.  Accumulated  debris  adhering  to  the 
edge  of  ulcerations  should  be  removed  with  forceps. 
The  curette  may  be  employed  for  necrotic  tissue 
when  necessary.  All  sequestra  should  be  removed, 
but  it  is  advisable  to  wait  until  separation  has  oc- 
curred.    (Bos.) 

Galvano- Cautery: — May  sometimes  be  useful  in  re- 
ducing indurations.     (Ing.) 

HEREDITARY  SYPHILIS  OF  THE  NOSE. 

The  local  treatment  should  mainly  consist  of 
cleansing  and  disinfecting  lotions,  as,  for  example : 


:.    Sodii  Bicarbonatis, 

gr- 

iij 

Acid.  Carbolici 

(Calvert's 

5  No. 

I), 

M. 

J- 

Glycerini  Opt., 

3J. 

Aq.  Destill., 

[. 

q- 

s.  ad 

Eh 

590  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

In  applying  solutions  of  this  nature  some  writers 
advice  the  use  of  sprays  alone,  considering  the 
syringe  inexpedient.  The  latter,  however,  wall  be 
found  effective  if  the  infant  is  placed  on  the  nurse's 
knee  with  the  face  downward  and  the  nose  then 
syringed  out. 

Menthol : — 1  part,  olive  oil  9  parts,  applied  with  a 
camel's  hair  brush,  is  useful  for  temporarih'  relieving 
erectile  swelling. 

Cocaine  Hydrochlorate: — If  the  parts  are  much 
swrollen  and  sensitive  a  few  drops  of  a  4  per  cent,  so- 
lution may  be  applied  before  using  the  SA^ringe. 

The  following  is  a  useful  ointment  for  application 
to  the  nostrils : 

5fc.    Aristoli,  gr.  x. 

Lanolini, 

Vaselini,  aa  gss. 

M.  (Bn.) 

SYPHILIDES. 

Local  treatment  will  be  required  Avhen  the  lesions 
are  situated  on  the  hand  or  face,  and  when  it  is  de- 
sirable to  hasten  their  disappearance  on  account  of 
profuse  and  disagreeable  discharges. 

Before  the  application  of  the  proper  medication, 
all  crusts  should  be  removed  by  v^arm  antiseptic  so- 
lutions. 

Ung.  Hydrarg.  Inunctions: — Used  in  various  syph- 
ilideswrith  the  best  results. 

Calomel  and  Traumaticin: — A  bath  is  first  given, 
then  a  25  per  cent,  mixture  of  calomel  in  traumaticin 
is  painted  on  where  there  are  any  syphilitic  manifes- 
tations. The  results  are  said  to  be  very  favorable  in 
syphilides  of  the  papular,  pustular  and  squamous 
varieties,  and  in  small  circumscribed  lesions.     (CI.) 


SYPHILIS.  591 

Hydrarg.  Oleati: — 20  per  cent,   ointment  for  dry 
lesions. 

For  ervthematous  forms : 


(B.  H.) 


«t. 

Resorcini, 

3ss. 

Adipis  Benzoinati, 

3J- 

M. 

5fc. 

Hydrarg.  Chloridi  Mitis, 

Pulv.  Amyli, 

aa  5J- 

M. 

^. 

Hydrarg.  Chloridi  Mitis, 
Ung.  Zinc.  Oxidi, 

3j. 

Ung.  Petrolei, 

aa  5ss. 

M. 

'or 

papular  forms : 

¥fc. 

Hydrarg.  Praecipitati  Albi, 
Amyli, 

3J. 

Zinc.  Oxidi, 

aa  3ij. 

Vaselini, 

adSJ. 

M. 

?t. 

Ung.  Hydrarg.  Ammoniati, 

9j- 

Ung.  Aq.  Rosse, 

IJ. 

M. 

^. 

Hydrarg.  Chloridi  Mitis, 

Ung.  Petrolei  Carbolat., 

aa  ,^ss. 

M. 

;w.  M.) 


;b.  H. 


(W.  M.) 

For  pustular  forms  Hot  Vapor  Baths  followed  by 
one  of  these  ointments : 


^. 

Hydrarg.  Bichloridi, 
Ung.  Hydrarg.  Nitratis, 

gr.  ij. 

Ung.  Petrolei, 

aa  ,^ss. 

M. 

^. 

Ung.  Zinc.  Oxidi, 

3vj. 

M. 

Hydrarg.  Oxidi  Rub. , 

3ij. 

(W.  M, 

592  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Alkaline  Baths: — Indicated  in  scaly  lesions,  partic- 
ularly those  of  the  palms,  which  are  difficult  to  cure. 

Labarraque's  Solution: — In  conjunction  with  wet 
dressing,  is  of  service  in  macerating  hard  crusts.  (Al.) 

Liq.  Potassae: — Pure  or  diluted,  may  be  used  on 
hard  indurated  lesions.     (B.  H.) 

The  following  are  also  for  lesions  of  a  hard  scaly 
character : 

9;.    Ung.  Hydrargyri, 

Amyli, 

Zinc.  Oxidi, 

Vaselini,  Partes  equales. 

M. 

^.    Hydrarg.  Chloridi  Mitis,  gr.  xx. 

Zinc.  Oxidi,  5^3- 

Amyli,  5ij. 

Vaselini,  ad  gj- 

M.  (B.  H.) 

Dusting  powders  are  of  benefit,  namely :  Aristol, 
Europhen,  Europhen-Aristol,  Dermatol,  Calomel, 
Iodoform,  Lycopodium  and  Bismuth  Subnitrate,  and 
Nosophen.     (CI.) 

Ung.  Diachylon: — When  a  soothing  application  is 
necessary. 

Mercurial  Plasters: — Have  excellent  effect  on  thick- 
ened epidermis  and  gummata. 

SYPHILITIC   ULCERS,  Compare  Ulcers. 

Aristol: — Has  a  remarkable  influence  on  ulcers  of 
this  variety,  and  is  regarded  as  superior  to  any  other 
agent.     (Sm.) 

Iodoform: — Has  been  freely  used  in  various  forms, 
but  is  generally  disappointing  for  open  ulcerations. 
(M.) 


SYPHILIS.  593 

Hydrarg.  Oxid,  Rub.: — Equal  parts  with  starch 
forms  an  excellent  dressing  when  granulations  are 
indolent  (Al.),  or  the  officinal  ointment  diluted  in  the 
proportion  of  1  part  to  8  or  10  of  sulphur  ointment. 
(N.) 

Hydrarg.  Salicylas: — A  lotion  of  5  grains  of  the 
salt,  with  5  grains  of  carbonate  of  potash,  to  the 
ounce  of  distilled  w^ater,  or  an  ointment  of  16  grains 
to  the  ounce.     (Al.) 

Hydrarg,  Sozoiodas: — An  ointment  of  2  to  10  per 
cent,  or  dusting  powders  of  the  same  strength  with 
talc  or  starch.     (F.) 

Lotio  Flava: — A  strong  stimulant  and  detergent  to 
foul  ulcers. 

The  following  are  advantageously  applied : 

For  inflamed  ulcers : 


(Sm. 


B.  T. 


^.    Hydrarg.  Chloridi.  Mitis, 

gr.  X, 

Naphtholini, 

3J. 

Ung.  Camphorae, 

5vij. 

M. 

^.    Emplast.  Plumbi, 

Sij- 

Ung.  Hydrarg., 

3ss. 

Ol.  Cadini, 

3ij. 

M. 

For  phagedaenic  ulcerations : 

9;.    Acid.  Pyrogallici, 

3J- 

Vaselini, 

3v. 

M. 

^.    Acid.  Pyrogallici, 

Amyli, 

aa  jvj. 

Vaselini, 

3xvii 

M. 

(N.) 

For  very  chronic  ulcers  energetic  treatment  is  re- 
quired;   the    Cautery,    Acid    Nitrate    of    Mercury, 
39 


594  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Chromic  Acid  or  Zinc  Chloride  (the  last  preferable) 
are  indicated.  Applications  should  be  preceded  by 
cocaine. 

The  following  ointment  is    also    useful    for    very- 
chronic  types : 

ik.    Acid.  Tannici,  gr.  Ixxv. 

Liq.  Hydrarg,  Nitratis,  gtt.  xij. 

Adipis,  S^iiss. 
M.  (Sn.) 


TATTOO  MARKS. 

Dr.  Variot,  of  Paris,  claims  to  sttccessfulh^  remove 
tattoo  marks  in  the  following  manner:  A  concen- 
trated solution  of  Tannin  is  applied  to  the  skin,  and 
worked  in  the  same  way  as  in  the  tattoo  operation. 
The  skin  is  then  rubbed  with  a  crayon  or  a  solution 
of  Nitrate  of  Silver,  which  is  allovv^ed  to  remain  on 
until  the  tattoo  marks  stand  out  as  black  points  on 
the  tannate  of  silver.  Any  excess  of  fluid  should  be 
wiped  off.  The  surface  turns  black  and  moderate  in- 
flammation ensues ;  after  fourteen  or  fifteen  days  the 
eschar  drops  ofl",  leaving  a  red  superficial  cicatrix, 
which  after  about  two  months  will  disappear.  (Sh.) 
Bioxalate  of  Potassium  may  be  used  in  place  of 
nitrate  of  silver.  Antiseptic  precautions  should  be 
enjoined  in  making  the  applications  and  the  tattoo 
needle  employed  to  remove  tottoo  marks.     (Sj.) 


TETANUS. 

The  wound  should  receive  the  most  energetic  anti- 
sepsis. 


TETANUS.  .  595 

Antitoxine : — Recent  writers  claim  that  this  treat- 
ment has  reduced  the  death  rate  from  80  per  cent,  to 
37.37  per  cent.     (A.) 

Roux  and  Vaillard  recommend  the  following :  The 
wound  is  first  excised,  then  100  c.c.  of  the  active 
serum  is  injected ;  the  injection  is  repeated  the  next 
and  the  following  day,  and  continued  daily  as  long 
as  symptoms  last.  The  serum,  while  it  neutralizes 
the  poison  in  the  blood,  does  not  act  upon  the  germs 
at  the  wound,  so,  unless  the  source  of  infection  can 
be  removed,  the  disease  maj^  return.  It  is  advisable, 
therefore,  to  keep  up  the  injection  for  ten  to  twelve 
days  after  the  disappearance  of  symptoms  in  order 
to  guard  against  recurrence.     (F.) 

Behring's  Antitoxin  is  undoubtedly  effective  in  the 
treatment  of  traumatic  tetanus,  and  sliould  be  ad- 
ministered in  all  forms.  1.  It  is  best  to  give  it  as 
early  as  possible.  2.  The  local  treatment,  which  con- 
sists in  a  complete  destruction  of  the  primary  lesion 
as  soon  as  possible,  must  not  be  omitted,  for  it 
might  tend  to  a  constant  supply  of  toxine.  3.  The 
symptomatic  treatment  with  sedative  drugs  must  be 
pursued  in  conjunction  with  serum  therapy,  as  it 
maybe  effective  when  the  latter  fails.  4.  Old  methods 
for  eliminating  the  poison  from  the  body  must  not 
be  neglected.  5.  The  preventive  treatment  leaves 
much  for  further  investigation.    (I.  M.  R.,  4,  16,  96.) 

Hydrarg.  Bichlorid.: — Celli's  Treatment:  The  hy- 
podermic injection  of  this  drug  has  been  attended 
with  success.  A  case  is  reported  in  which,  after  the 
failure  of  other  remedies,  injection  into  the  buttocks 
of  j^^  grain  tv^ice  daily  resulted  successfully.  After 
the  second    dose  the  convulsions  decreased    in  fre- 


596  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

quency  and  severitj',  and  after  the  seventh  ceased 
entirely.     (F.) 

Carbolic  Acid: — By  hypodermic  injection,  Baccelli's 
method,  has  been  used  successfully,  though  the  exact 
status  of  the  treatment  remains  uncertain;  success 
has  been  reported  from  doses  of  yV\  grain  of  the  acid 
every  two  hours  (F.),  and  apparently  hopeless  cases 
recovered  after  the  administration  of  12  drops  of  a  2 
per  cent,  solution  injected  every  three  hours.     (Sj.) 

Ascoli,  in  a  recent  monograph  (Bull,  della  R.  Acad- 
emia  Medica  di  Roma,  1897,  1898,  Fasc.  IV.),  con- 
cludes that  carbolic  acid  injections  give  better  results 
than  those  obtained  from  serum.  Under  its  influence 
the  convulsions  diminish,  the  acid  apparently  acting 
as  an  antitoxic  and  sedative  to  reflex  action,  while 
the  serum  acts  only  as  a  preventive  and  as  a  cura- 
tive in  the  earlier  stages  of  the  disease.  He  cautions 
against  the  fear  of  producing  carbolic  acid  poison- 
ing; in  some  instances  a  daily  dose  of  5^  grains 
v^ras  administered.  The  dosage,  according  to  Ascoli, 
is  as  follow^s :  %  to  %  grain  in  the  form  of  a  2  to  3 
per  cent,  solution,  injections  given  several  times  in 
twenty-four  hours. 

Morphia: — Injections  in  the  tetanized  muscles  give 
relief.     (B.) 

Ether  Spray: — Apply  to  vertebral  column,  from 
three  to  five  minutes  every  three-quarters  of  an  hour, 
first  along  the  spine,  and  later  along  the  affected 
parts.     (Sj.) 

Ice  and  Cold  Water: — Continuous  application,  or 
irrigation  to  the  affected  parts  immediately  after  re- 
ceiving the  w^ound  maintained  night  and  day  for  one 
week,  is  recommended.     (Sj.) 


TOOTHACHE.  597 

Hot  Baths: — In  conjunction  with  other  measures 
and  sometimes  useful  adjuvants.     (T.,  96.) 

Curare: — Should  be  useful  for  its  effect  upon  the 
terminal  nerves,  but  as  yet  experience  does  not  con- 
firm it.  Dose,  2^5  grain  hypodermically,  cautiously 
increased.  The  strength  of  the  drug  may  vary.  (Ty.) 

Saline  Infusions: — Intravenous  or  subcutaneous, 
are  valuable  agents.     (F.) 

Rest: — A  most  important  therapeutic  measure. 
This  must  be  literally  absolute  in  the  strictest  sense 
of  the  word;  every  sound  should  be  excluded,  the  room 
darkened,  the  ears  plugged  w^ith  cotton,  draughts 
of  air  excluded,  and  the  attendance  must  be  so  con- 
ducted as  not  to  cause  the  slightest  noise.     (Gn.) 

Amyl  Nitrate  Inhalations  and  Anaesthetics  may 
be  administered  for  temporary  relief.     (B.) 


TOOTHACHE. 

See  also  Caries  of  the  Teeth, 

Dry  Heat: — This  much  used,  and  often  effective  pal- 
liative, may  be  applied  to  the  face  in  the  form  of  the 
hot  water  bag  or  a  bag  filled  with  hot  hop  flowers. 
A  poultice  should  never  be  used.  The  follow^ing  rem- 
edies are  to  be  applied  by  saturating  a  small  piece  of 
cotton,  inserting  it  in  the  cavity  of  the  carious  tooth 
and  coating  A^ath  collodion. 

Alum: — A  solution  in  nitrous  ether,  3J— 3vij,  is  said 
to  be  very  effective. 
Tannic  Acid: — Druitt's  formula  for  toothache,  viz.: 
Tannic  Acid,  9j. 

Mastich.,  gr.  x. 

Ether,  3ss. 

(B.) 


598  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Chloroform  and  Camphor: — A  mixture  of  these 
two  agents  forms  one  of  the  best  appHcations.     (N.) 

Essential  Oils: — Creosote,  commonly  used  ;  Cloves, 
Cajuput,  Chalmoogra,  Origanum,  Peppermint,  Sa- 
bina,  and  Thyme. 

Cocaine  Hydrochlorate: — May  afford  relief,  but  is 
apt  to  aggravate  the  condition  upon  which  the  pain 
depends. 

Atropine: — 1  per  cent,  solution. 

Aconite: — A  few  drops  of  the  tincture. 

Chloral  and  Camphor: — Equal  parts.     (F.) 

Capsicum: — A  few  drops  of  the  tincture  or  fluid 
extract  is  sometimes  used.     (N.) 

Orthoform: — Apiece  of  absorbent  cotton  saturated 
with  an  alcoholic  solution  placed  in  the  cavity  of  the 
tooth  is  said  to  relieve  immediately  the  pain.  The 
drug  being  antiseptic,  it  is  not  necessary  to  use  car- 
bolic acid.  In  pains  after  the  extraction  of  teeth  and 
roots,  cases  where  chloroform,  opium,  camphor, 
tincture  of  aconite,  cocaine,  etc.,  had  no  effect,  the 
remedy  has  been  used  with  pleasing  results.  It  has 
been  applied  after  the  extraction  of  an  entire  set  of 
teeth  when  numerous  wounds  were  present.  (T.  P., 
8,  99.)  Compare  paragraph  on  this  drug  under 
Anaesthesia. 

Odontine: — A  name  applied  to  various  prepara- 
tions for  the  teeth.    English  odontine  is  as  follows : 

Camphor,  "  5  parts. 

Alcohol,  ID  parts. 

Chloroform,  20  parts. 

The  following  is  said  to  constitute  a  useful  pallia- 
tive: 


TOOTHACHE.  599 

Oil  of  Cajuput,  2  parts. 

Oil  of  Cloves, 

Oil  of  Juniper,  each    3  parts. 

Ether,  24  parts. 

A  bit  of  cotton  is  saturated  with  the  above  and  inserted  into  cav- 
ity.     (F.) 

Odontol : — A  new  preparation ;  formula  as  follows : 

Cocaine  Hydrochlorate, 

Oil  of  Cherry  Ivaurel,  each    15  grains. 

Tincture  of  Arnica,  150  grains. 

Solution  of  Ammon.  Acetate,  300  grains. 

If  the  pain  is  caused  by  caries,  a  piece  of  cotton 
saturated  with  this  solution  should  be  inserted;  if 
by  inflammation  of  the  pulp,  the  mouth  should  be 
w^ashed  with  odontol  diluted  with  twice  its  bulk  of 
warm  linseed  tea ;  if  the  pain  extends  to  the  entire 
jaw,  the  part  should  be  rubbed  with  the  preparation. 
Caution  should  be  observed  lest  any  portion  is  swal- 
lowed.    (F.) 

Carbolic  Acid  and  Collodion : — These  agents  are 
fused  by  melting  crystals  of  the  acid  in  a  test  tube 
and  adding  equal  parts  of  collodion ;  the  mixture  is 
a  jelly.  When  first  inserted  into  the  tooth  there  will 
be  an  aggravation  of  pain,  followed  by  relief     (B.) 

Piscedia :  — The  most  reliable  preparation  is  the 
fluid  extract ;  it  ma3^  be  used  v^ith  much  benefit.  (F.) 

Phenoresorcin : — The  powder  placed  in  the  cavity 
will  afford  relief.     (B.) 

Tr.  Aconite  and  Tr.  Iodine: — Equal  parts,  with  or 
w^ithout  a  small  quantity  of  Chloroform,  painted  on 
the  gums  is  effective ;  in  some  instances  the  iodine 
alone  is  used.     (F. ) 

Carbonate  of  Soda: — A  saturated  solution  held  in 
mouth  relieves.     (B.) 


600  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Chloroform  Water: — May  be  used  as  a  mouth 
wash  for  toothache.     (N.) 

Chamomile:  —  The  flowers  steeped  in  hot  water 
and  inserted  into  a  small  lace  bag  and  applied  to  the 
gums  over  an  ulcerating  tooth  will  sometimes  afford 
relief. 

Pyrethrum : — The  tincture  is  emploj^ed  by  dentists 
to  relieve  toothache  and  as  an  ingredient  of  mouth 
washes. 


TONGUE,  FISSURE  OF. 

Nitrate  of  Silver: — The  crayon;  useful  when  the 
lesion  is  superficial.     (Bt.) 

Borax: — With  honey  or  glycerine,  a  popular  rem- 
edy, 40  grains,  vvrith  glycerine  1  ounce,  and  water  4 
ounces.     (N.) 

Hydrastis: — A  valuable  drug;  about  5  to  10  drops 
to  2  ounces  of  water  for  a  mouth  wash.     (R.) 

Nitric  Acid  5  drops,  v^'^ater  3  ounces,  or  Carbolic 
Acid,  same  strength,  are  both  recommended  for 
mouth  washes.     (Rd.) 


TONGUE,  ULCERS  OF. 

For  ordinary  simple  acute  ulceration  the  treatment 
mentioned  under  Stomatitis  and  Aphthae  will  suflSce. 
For  syphilitic  ulcerations,  as  far  as  external  remedies 
are  concerned,  the  same  w^ill  answ^er,  proper  internal 
medication  being  all  important. 

Lactic  Acid: — Applications  of  a  50  percent,  solu- 


TONSILS,    HYPERTROPHY   OF.  601 

tion    made  every  other    day,  graduall3^  increasing 
strength,  are  of  service  in  tuberculous  ulcerations. 

Chronic  ulcerations  should  be  removed  by  surgical 
means.     (F.) 


TONSILS,  HYPERTROPHY  OF. 

Enlarged  tonsils,  in  which  the  hypertophy  is  of 
long  standing,  and  the  tissues  are  dense  and  firm, 
will  not  yield  to  any  form  of  treatment,  and  should 
be  excised.  There  are  many  cases,  how^ever,  in 
Mrhich  the  tissues  are  less  dense  and  firm  and  the 
condition  not  so  chronic,  where  remedies  w^ill  pro- 
duce results. 

Astringents: — Are  both  recommended  and  con- 
demned as  of  doubtful  efhcacy ;  their  action,  it  is 
claimed,  being  limited  to  the  reduction  of  inflamma- 
tion, with  no  influence  upon  the  hypertrophied 
tissues. 

The  follov^ing  are  among  the  best : 

Glycerole  of  Tannin. 

Nitrate  of  Silver,  gr.  iij-v— ^j. 

Sulphate  of  Zinc,  gr.  v— x— §j. 

Sulphate  of  Copper,  gr.  iij-sj- 

Alum,  by  insufflation. 

Infusion  of  Catachu.     (F.)     (Iv.)     (Bos.) 

Ammonium  Iodide.: — 3ss,  with  glycerine 5j,  painted 
on  at  night,  has  proved  effective.     (Wa.) 

Iodine: — A  few  drops  injected  into  the  gland  has 
been  used,  but  the  procedure  is  open  to  objection. 
(Bos.) 

Trichloracetic  Acid: — Has  been  found  useful,  em- 
ployed in  the  follo"wing  solution : 


602  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

V^.    Acid.  Trichloracetic!,  gr.  v. 

Sodii  Carbonatis,  gr.  ij. 

Potass.  lodidi,  gr.  iiss. 

Glycerini,  gj. 
M.  (F.) 

Tonsillotomy: — This  is  the  one  measure  of  reUef 
which  should  be  advocated  in  all  cases  unless  there 
are  special  reasons  contra-indicating  it.  The  gland 
may  be  best  removed  bj'  the  tonsillitome,  galvano- 
cautery,  ecraseur,  or  cold  wire  snare.  In  a  large  ma- 
jority of  cases  the  tonsillitome  is  the  best  instru- 
ment. The  galvano-ecraseur  possesses  the  advan- 
tage of  extirpating  without  haemorrhage;  it  is,  how- 
ever, slow  and  difficult  to  manipulate  with  children 
unless  an  anaesthetic  is  administered.  In  adults  it 
may  be  used  to  advantage  in  order  to  avoid  haemor- 
rhage, which  should  always  be  anticipated.  (Bos.) 
In  using  this  instrument  the  \vire  should  not  be  al- 
lov^''ed  to  go  too  deeply  or  to  destroy  tissue  beyond 
the  incision. 

Cold  Wire  Snare: — When  the  tonsil  is  fiat  and 
deeply  imbedded  between  the  pillars  of  the  fauces  and 
it  is  impossible  to  reach  it  with  a  tonsillitome  this 
can  be  used  with  advantage.  The  haemorrhage  after 
tonsillotomy  is  usuallj'-  slight;  it  is  advisable,  how- 
ever, to  allowr  the  patient  to  hold  cold  w^ater  in  the 
mouth,  in  which  a  little  Gallic  or  Tannic  Acid  has 
been  dissolved.  If  haemorrhage  persists,  saturated 
solutions  of  these  remedies  may  be  applied.  If 
styptics  are  required,  which  is  rarely  the  case,  apply 
a  saturated  solution  of  Chromic  Acid. 

In  all  operations  it  is  important  to  avoid  wound- 
ing the  pillars  of  the  fauces,  lest  haemorrhage  occur, 
and  loss  of  control  of  the  muscles  result. 


TONSILS,   HYPERTROPHY   OF.  603 

Suprarenal  Extract: — For  the  use  of  this  agent  in 
controlhng  haemorrhage  during  operations  on  the 
nose  and  throat  see  Adenoid  Growths  of  the 
Pharynx. 

Galvano-Cautery: — Of  the  local  destructive  agents 
used  for  the  removal  of  the  tonsils,  this  may  be 
regarded  as  the  most  satisfactory.  It  is,  however, 
a  slow  process.  A  slender  pointed  electrode  should 
be  selected  and  a  number  of  punctures  made  with 
it  in  the  face  of  the  hypertrophied  gland.  This  is 
better  than  superficial  burning.  Ivins  recommends 
the  galvano-cautery  for  hypertrophied  tonsils  w^ith 
large  open  crypts.  The  point  of  the  needle  should 
be  thrust  into  the  opening  of  the  crypt  while  the 
current  is  turned  on  and  removed  while  hot  in  order 
to  avoid  unnecessary  pain.  Two  or  three  lacunae 
are  thus  treated  at  a  time.  Cocaine  may  be  first  ap- 
plied. The  reaction  is  slight  and  the  treatment  may 
be  repeated  in  five  days.  This  method  is  usually  the 
most  satisfactory  for  treating  lacunar  tonsillitis.  If 
there  are  bands  of  tissue  Avhich  prevent  the  free  exit 
of  caseous  masses  they  should  be  divided  or  torn 
w^ith  a  probe  and  the  cavities  emptied.     (Iv.) 

Mineral  Caustics: — These  are  slow^,  unsatisfactory 
and  require  great  caution  in  application,  lest  neigh- 
boring tissues  are  destroyed ;  their  use  is  not  gener- 
ally commended.  Chromic  Acid  is  the  best  of  these 
agents,  and  continues  to  be  advocated  by  some 
authorities.  The  fused  acid  on  the  point  of  a  probe 
may  be  used  on  enlarged  glands  with  open  and  dis- 
tended crypts.     (Iv.) 


604         DIGEST   OF   EXTERNAL  THERAPEUTICS. 


TONSIL,  HYPERTROPHY  OF  THE 
LINGUAL. 

The  general  indications  are  correction  of  the  irri- 
tant character  of  the  buccal  secretions  and  the  re- 
moval of  the  growth.     (L-  B.) 

Iodine: — The  glycerole  may  be  painted  on.     (Ba.) 

Chromic  Acid: — This  agent  is  condemned  by  Len- 
nox Browne  as  dangerous.  Its  use,  however,  is  al- 
io w^ed  by  other  v^riters  (P.  M.),  especially  with  the 
mirror,  and  under  full  illumination,  when  pain  and 
danger  are  minimized.  The  fused  acid  on  a  probe 
after  cauterization  is  employed. 

Galvano-Cautery: — This  is  undoubtedly  the  best 
agent  for  the  removal  of  redundant  tissues ;  the  por- 
celain point  or  caustic  snare  may  be  used.     (L.  B.) 

Cold  W^ire  Snare: — Suitable  for  the  removal  of 
large,  prominent  masses.     (P.  M.) 


TONSILLITIS. 

ACUTE  FOLLICULAR  TONSILLITIS. 

Importance  of  local  treatment  is  now  recognized ; 
mild  antiseptic  sprays  and  gargles  should  be  em- 
ployed. 

Hydrogen  Peroxide: — 1  part  to  8  of  water  does 
efficient  service.     ( F. ) 

Creosote: — As  a  gargle,  1  to  2  drops  to  the  ounce 
of  water.     (T.,  98.) 


TONSILLITIS.  605 

Salol: — 5  percent,  alcoholic  solution,  1  drachm  to 
2  ounces  of  lukewarm  \^ater. 

Izal: — 1-200,  as  spray  is  said  to  tend  to  shorten 
attack.     (T.,  96.) 

Iron  Sulphate  (Monsel's  Solution):  —  Applied  un- 
diluted to  the  seat  of  inflammation  will  quickly  con- 
stringe  the  inflamed  tissues,  and  promote  recovery. 
Apply  twice  daily.     (F.) 

Potassium  Chlorate: — Solutions  may  be  used  as  a 
gargle  in  the  intervals  of  application  of  Monsel's  so- 
lution. Solutions  of  3j— ^iv,  generally,  as  a  gargle. 
(P.  M.) 

Simple  gargles  of  Boric  Acid,  Borax,  Phytolacca, 
and  Boroglyceride  1  to  5. 

ACUTE  SUPPURATIVE  TONSILLITIS— QUINSY. 

Ice : — Constantly  holding  small  bits  of  ice  in  the 
mouth  during  the  onset  of  the  disease  is  often  useful 
for  allaying  heat  and  pain. 

Sodium  Bicarbonate: — The  patient  should  be  pro- 
vided with  a  saucer  of  soda,  and  every  half  hour,  by 
simply  wetting  the  forefinger,  he  can  smear  the  in- 
flamed fauces  with  the  remedy.  This  simple  proced- 
ure is  highly  recommended  for  relieving  the  pain. 
(Bos.) 

A  saturated  solution  is  also  used  as  a  gargle  for 
relief  of  the  accumulation  of  ropy  mucus. 

Hot  Compresses: — Flannels  wrung  out  in  hot 
water  and  laid  over  the  region  of  the  tonsils  is  sooth- 
ing to  some  patients. 

Tr.  Guaiacum : — 1  drachm,  to  hot  w^ater  1  ounce, 
held  in  the  mouth  may  be  comforting  in  the  early 
stages  of  the  disease.     (Iv.) 


606  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Nitrate  of  Silver: — A  drachm  to  the  ounce  painted 
on  once  or  twice  a  day  may  be  said  to  be  successful 
in  aborting  one  case  in  four ;  two  or  three  applica- 
tions usually  necessar^^     (Ing.) 

Steam  Inhalations: — In  earlj^  stages,  lasting  five 
to  ten  minutes.  A  little  eucalvptol  may  be  added. 
(Iv.) 

Hot  Water  Gargles: — Useful  in  second  stage.  (Ba.) 

Incision : — As  soon  as  the  presence  of  pus  is  ascer- 
tained, an  incision  should  be  made,  followed  by  hot 
gargles  for  facilitating  the  escape  of  pus.  In  some 
cases  it  is  desirable  to  pass  a  director  into  the  open- 
ing to  prevent  too  early  closure.     (Ba.) 

After  recovery  when  the  glands  remain  large  they 
may  be  painted  w^ith  the  following : 

^.    lodi,  gr.  vj. 

Potass.  lodidi,  gr.  xij. 

Ol.  Menth.  Pip.,  M.v. 

Glycerini,  ad  gj- 
M.  (P.  M..) 


TORTICOLLIS  OR  STIFF  NECK. 

See  Muscular  Rheumatism. 

TRACHOMA. 

This  disease  exists  in  so  many  varying  degrees  of 
severity,  and  the  classifications  of  its  types,  according 
to  different  writers,  present  such  divergences,  that 
a  concise  summary  of  the  plans  of  treatment  is  diffi- 
cult.   For  those  cases  attended  with  intense  photo- 


TRACHOMA.  607 

phobia,  lachrymation,  vascular  keratitis,  and  even 
iritic  disease,  which  appear  in  all  grades  of  severity, 
the  following  preliminary  treatment  is  recommended 
by  Roosa : 

Hot  Water: — This  should  be  employed  as  a  fomen- 
tation, using  absorbent  cotton  dipped  in  boiling 
water,  applied  continuously  to  the  eyes  for  twenty 
minutes  about  six  times  a  day. 

Sulphate  of  Atropia: — Instillations  three  to  six 
times  a  day  of  a  solution  of  the  strength  of  2  grains 
to  the  ounce. 

Scopolamine  Hydrobromate: — Instillations  of  a 
solution,  a  grain  to  the  ounce,  may  be  substituted 
for  atropine,  if  desired. 

Cocaine  Hydrochlorate: — If  this  is  successful  in  re- 
lieving the  photophobia  it  may  be  repeated,  using 
considerable  quantities  from  four  to  six  times  a  day ; 
the  solution  should  contain  8  grains  to  the  ounce. 
These  measures  \vill  lessen  the  photophobia  and 
lachrymation,  and  prepare  the  eyes  for  the  use  of 
astringents,  of  which  Tannic  Acid,  in  the  form  of  a 
spray,  or  Alum  Crystals,  applied  once  or  twice  a 
day,  are  recommended  as  the  best  w^ith  which  to 
begin.     (Ro.) 

Sulphate  of  Copper: — If  the  disease  gradually  yields 
to  the  above  line  of  treatment  this  remedy,  in  the 
form  of  the  crayon  or  crystals,  may  be  applied  once 
or  twice  a  day.  The  results  in  a  few^  w^eeks,  even 
in  the  most  obstinate  cases,  will  be  satisfactory. 
(Ro.)  Sulphate  of  copper  is  generally  regarded  as 
one  of  the  best  preparations  for  ordinary  forms  in 
w^hich  there  is  little,  if  any,  purulent  discharge,  and 
w^here  there  is  considerable  thickening  of  the  con- 
junctiva.    The  effect  can  easily  be  regulated  from  a 


608  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

slight  to  an  almost  caustic  action  according  to  the 
heaviness  of  the  touch.  Applications  should  be  re- 
peated from  every  other  day  to  once  or  twice  a 
week;  every  part  of  the  conjunctiva  within  reach 
should  be  touched,  including  the  retrotarsal  folds. 
(N.O.) 

This  following  antiseptic  lotions  applied  to  the 
everted  eyelids  are  recommended : 

Mercuric  Bichloride,  1-1000. 

Carbolic  Acid,  gr.  vj,  glycerine,  .^. 

Formalin,  1-1000-2000.     (Bl.) 

Tannic  Acid: — Solutions  in  glycerine  from  10 
grains  to  the  ounce  up  to  a  saturated  solution  are 
very  effective.  In  chronic  intractable  cases  they  may 
be  used  twice  a  day,  a  drop  in  the  conjunctival  sac. 
(Ro.) 

A  solution  of  15  grains  to  the  ounce  is  also  recom- 
mended for  painting  on  the  everted  eyelid.     (Bl.) 

Nitrate  of  Silver: — The  crayon  should  never  be 
used  under  any  circumstances ;  the  mitigated  crayon 
(equal  parts  of  nitrate  of  silver  and  nitrate  of  pot- 
ash) and  a  solution,  gr.  v-x-5J,  should  be  limited,  if 
used  at  all,  to  cases  w^here  there  is  marked  purulent 
secretion.     (N.  O.) 

Ichthyol: — Is  said  to  have  excellent  effect,  viz.: 

9:.    Ichthyoli,  3  v. 

Aq.  Destill  ,  ^iv. 

Glycerini,  3J. 
M. 

Sig.     The  everted  eyelids  are  painted  with  the  mixture,  which 

is  permitted  to  remain  on  from  sixty  to  ninety  seconds, 
then  washed  off  with  water. 

It  is  indicated  at  every  stage.  In  children  a  30  per 
cent,  solution  may  be  used.     (T.,  98.) 


TRACHOMA.  609 

Jequirity: — Burnett  says  this  remedy  is  now  very 
little  used  because  of  the  danger  to  the  cornea,  which 
is  liable  to  become  ulcerated  unless  the  pannus  is 
very  dense.  Roosa,  however,  says  he  has  used  it  a 
great  deal,  and  in  no  case  was  there  damage  to  the 
cornea.  The  same  writer  recommends  that  the  rem- 
edy first  be  converted  into  a  powder.  The  patient  is 
placed  under  the  care  of  an  attendant,  and  the  pow- 
dered drug,  to  the  amount  of  a  grain,  is  applied  to 
the  palpebral  conjunctiva.  In  most  cases  there  is  re- 
action, consisting  of  pain  in  the  lids,  redness  and 
oedema;  for  this  ice  cloths  maybe  applied.  A  mem- 
branous deposit  v^'ill  be  formed  upon  the  conjunctiva 
in  about  four  hours;  further  use  of  the  drug  must 
then  be  stopped.  In  obstinate  cases  it  is  necessary 
to  repeat  the  application  once,  twice,  and  occasion- 
ally even  three  or  four  times.  When  the  inflamma- 
tion produced  by  the  application  subsides  the  cornea 
will  be  less  vascular,  the  photophobia  decreased  and 
the  condition  such  as  to  call  for  the  use  of  astring- 
ents, which  should  finish  the  treatment. 

Sulphate  of  copper  is  especially  indicated  at  this 
period.  The  care  of  an  attendant  is  necessarry  for 
the  safe  application  of  jequirity.     (Ro.) 

The  surgical  measures  for  chronic  cases  are  the  fol- 
lowing : 

Expression  : — Of  the  operative  methods  this  is  pref- 
erable. It  consists  of  squeezing  out  the  morbid  tis- 
sues. The  patient  must  be  anaesthetized,  the  lids 
everted,  and  the  loose  rolls  of  the  conjunctiva  seized 
with  the  forceps,  and  stripped  of  the  contents  by  a 
slow^  movement.  This  is  continued  until  all  tracho- 
matous granules  have  disappeared.  The  conjunctiva 
is  then  washed  with  boric  acid ;  the  eyes  are  left  open 
40 


610       '  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

afterward.  In  a  few  daj'S  astringents  may  be  ap- 
plied. The  conjunctiva  is  congested  for  some  time, 
but  this  gradually  disappears  and  recovery  occurs 
with  little  morbid  tissue  remaining  and  but  little 
contraction.     (Ro.) 

Grattage: — After  anaesthesia  the  lids  are  everted, 
the  fornix  exposed,  and  put  on  the  stretch  over  the 
blade  of  the  forceps.  The  conjunctiva  is  scarified  by 
making  incisions  close  together,  parallel  to  the  mar- 
gins of  the  lids.  These  incisions  are  united  by  others 
running  transversely,  the  depth  of  the  incisions  de- 
pending upon  that  of  the  trachomatous  tissue ;  they 
generally  pass  through  it.  The  surface  is  then 
scraped  thoroughly  with  a  tooth  brush,  having 
short  stiff  bristles,  dipped  in  a  solution  of  bichloride 
of  mercury,  1-500.  The  eye  is  then  washed  and 
bandaged  with  an  antiseptic  dressing.  The  rubbing 
is  repeated  every  day  after  the  operation  for  tw^o 
weeks,  this  frequently  depending  upon  the  amount  of 
reaction.  QEdema  of  the  lids  A\dll  follow,  but  it  is 
claimed  by  those  who  endorse  the  procedure  that  the 
reaction  is  generally  slight.  The  operation  does  not 
meet  with  general  approval.     (Ro.) 

Galvano-Cautery : — This  is  another  method  used 
for  touching  the  trachomatous  granules,  but  it  is  in- 
ferior to  the  method  of  expression  when  properly 
executed.  Its  use  is  best  adapted  to  discreet  forms 
with  little  engorgement.     (N.  O.) 

Proper  hygienic  surroundings  are  of  much  import- 
ance. Overcrowding,  smoke,  dust,  and  bad  atmo- 
sphere of  any  kind  should  be  avoided.  High  alti- 
tudes exercise  a  favorable  influence  on  the  disease,  as 
it  is  likely  to  do  in  all  forms  of  dyscrasia.  Outdoor 
exercise  or  w^ork  is  beneficial,  provided  it  is  not  amid 


TRICHOPHYTOSIS — RINGWORM.  611 

dirt,  dust  or  smoke,  or  in  stables  or  at  farm  work. 
(N.  O.) 


TRICHOPHYTOSIS— RINGWORM. 

TRICHOPHYTOSIS  BARBJE. 

Treatment  must  be  governed  by  the  duration  of 
the  disease  and  the  condition  of  the  hair  follicles, 
whether  they  are  involved,  or  the  affection  is  mainly 
superficial ;  also  by  the  extent  of  inflammation. 

It  is  a  matter  of  the  utmost  importance  that  the 
disease  be  prevented  from  invading  the  follicles.  This 
may  be  accomplished  as  follows :  The  beard  on  the 
affected  part  should  be  clipped  close  with  a  pair  of 
curved  scissors,  not  shaved,  lest  the  disease  be 
spread.  Scales  or  crusts,  if  present,  should  be  re- 
moved by  w^ashing  with  v^arm  w^ater  and  potash 
soap  thoroughh^  applied,  and  the  loose  hairs  pulled 
out,  after  which  an  alcoholic  solution  of  Boric  Acid, 
3j— 3J,  or  Bichloride  of  Mercury,  1—400  or  500,  or 
Carbolic  Acid,  3J— giv,  should  be  used  on  the  hairy 
part  of  the  face.  After  drying  thoroughly  a  strong 
parasiticide  should  be  applied.     (B.  H.) 

While  the  remedies  for  trichophytosis  capitis  are 
generally  applicable  to  this  form  of  the  disease,  the 
following  are  worthy  of  especial  mention: 

Chrysarobin: — An  ointment  of  gr.  xxx— 5J  is  em- 
ployed advantageously.  The  disadvantages  attend- 
ing this  drug  must  not,  how^ever,  be  forgotten. 
(Mor.)  Dr.  W.  T.  Corlett  recommends  a  solution, 
in  traumaticin  or  collodion,  gr.  xx-xxx-^j,  to  be 
painted  on  when  there  are  only  t-wo  or  three  lesions. 


612  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

The  coating  should  be  removed  daily,  the  hair 
clipped  and  the  varnish  reapplied. 

Iodine  : — When  there  is  much  irritability  and  there 
are  several  lesions,  the  tincture  may  be  painted  on  as 
often  as  the  condition  of  the  skin  permits.     (Ck.) 

Hydrarg.  Bichlorid.: — Very  effective;  may  be  used 
as  follows : 

9^.    Hydrarg.  Bichlorid.,  gr.  viij. 

Alcoholis,  §  j . 

Hamamelidis  Destill.,  5"j- 
M.  (Sh.> 

Sulphur: — The  following  combination  is  effective: 

9;.    Sulphur.  Praecipitati,  gj. 

Acid.  Carbolici,  9j. 

Vaselini,  ^j. 

M.  (Hd.) 

Sig.     Appl}'  twice  daily. 

Copper  Oleate: — This  remedy  occupies  a  prominent 
place  in  the  treatment  of  this  affection,  viz.: 

9.    Cupri  Oleati,  gss. 

Lanolini  Cum  Oleo,  ^  j. 

M.  -  (Ck.) 

9.    Cupri  Oleati,  9j. 

Ol.  Chamomillae,  gtt.  v. 

Ung.  Zinci  Oxidi,  ^j. 
M.  (Sh.) 

Hyposulphite  of  Soda: — 1  part  to  8  of  distilled 
w^ater,  mopped  on  the  affected  part  three  or  four 
times  daily,  is  useful.     (Hd.) 

When  the  hair  follicles  are  involved,  the  pathogen- 
etic changes  are  deep-seated,  and  the  condition  is 
similar  to  kerion.  The  indications  for  treatment 
under  these  circumstances  may  be  briefly  summarized 
as  follows : 


TRICHOPHYTOSIS — RINGWORM.  613 

1.  Remove  the  crusts  by  soaking  in  oil,  and  after- 
AA^ards  washing  w^ith  w^arm  water  and  potash  soup. 

2.  Epilation  and  shaving  daily  or  on  alternate 
days. 

3.  The  application  of  penetrating  parasiticides, 
such  as  the  Oleate  of  Mercury  (20  per  cent.),  30 
grains,  Sulphur,  30  grains,  with  lanolin,  4  drachms, 
oil  of  almonds,  2  drachms,  thoroughly  rubbed  on  the 
skin  three  times  daily;  or  Oleate  of  Copper,  30 
grains  to  the  ounce,  or  Ichthyol,  half  a  drachm  to 
the  ounce.    (Corlett.) 

When  there  is  much  inflammation.  Scarification 
and  the  application  of  saturated  Boric  Acid  lint 
compresses  is  recommended  by  Besnier.  As  the 
growth  of  the  parasite  is  favored  by  moist  heat, 
poultices  are  contra-indicated. 

TRICHOPHYTOSIS  CAPITIS. 

This  is  one  of  the  most  obstinate  forms  of  ring- 
w^orm.  The  hair  should  be  cut  short  and  the  scalp 
scrubbed  v^ith  soap  and  water,  using  preferably  tar 
soap;  the  diseased  hairs  should  be  pulled  out  with 
forceps,  and  a  parasiticide  applied.  In  boys,  w^hen 
the  eruption  is  extensive,  the  scalp  may  occasionally 
be  shaved.  During  the  course  of  the  treatment  it 
will  be  necessar}^  to  thoroughly  free  the  scalp  from 
the  accumulation  of  epithelial  scales,  broken  hairs 
and  medicaments ;  for  this  purpose  use  German 
Green  Soap,  Soft  Soap,  or  Tincture  of  Soap;  after- 
wards the  parts  should  be  dried  with  alcohol  or 
ether. 

As  the  fungus  retains  its  vitalitj^  several  years  all 
the  articles  worn  about  the  head  and  neck  should  be 


614  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

burned.  Stringent  prophylactic  measures  must  be 
observed  in  regard  to  unaffected  children  who  are  ex- 
posed to  the  disease.  The  most  scrupulous  cleanH- 
ness  must  be  enforced,  and  no  healthy  child  be  per- 
mitted to  sleep  with  one  who  is  affected  or  use  the 
same  brush,  comb,  towel,  cap,  or  other  article.  Bad 
hygienic  surroundings  should  also  be  corrected,  such 
as  damp  or  ill- ventilated  apartments.  As  a  prophy- 
lactic measure  it  is  advised  to  keep  the  hair  cut  short 
and  apply  an  antiseptic  wash,  such  as  a  Saturated 
Solution  of  Borax  or  Carbolized  Oil. 

Epilation: — In  acute  or  recent  cases,  when  the 
fungus  has  not  penetrated  very  deeply,  the  ordinary 
parasiticides  are  often  successful  without  the  neces- 
sity of  epilation.  In  the  cases  commonly  encountered^ 
however,  the  disease  has  existed  for  some  time,  and 
this  measure  is  essential.  For  the  relief  of  pain 
Crocker  recommends  a  10  per  cent,  solution  of  Co- 
caine in  cosmoline,  or  Carbolic  Acid  in  glj^cerine,  1 
to  20.  Bazin  paints  the  parts  with  Oil  of  Cade, 
with  a  viev^  of  lessening  the  pain,  removing  about  a 
quater  of  an  inch  daily.  Rigolene  has  also  been  used, 
but  local  anaesthesia  is  not  very  successful. 

Of  the  numerous  drugs  which  have  been  extolled 
for  use  in  this  affection,  the  following  are  presented 
for  consideration.  It  must  be  borne  in  mind,  how- 
ever, that  thoroughness  and  persistence  in  applica. 
tion  are  most  essential  if  a  successfiil  result  is  to  be 
attained : 

Oleate  of  Mercury: — Highly  endorsed,  especially 
in  the  diffuse  form.  A  5  per  cent,  ointment  for  chil- 
dren under  8  years,  or  a  10  per  cent,  for  older  chil- 
dren. A  small  piece  is  rubbed  vigorously  into  the 
affected  part  night  and  morning ;  if  there  is  much 


TRICHOPHYTOSIS — RINGWORM.  615 

tenderness  it  may  be  omitted  for  a  day  or  two.  In 
the  early  stages,  when  there  are  only  a  few^  circum- 
scribed patches,  a  more  powerful  application  will  be 
required  ;  in  this  case  a  10  per  cent,  ointment  may  be 
employed.  (A.  W.)  Stronger  preparations  are  rec- 
ommended, as  1  drachm  of  the  20  per  cent,  ointment 
to  1  ounce.  This  must  be  used  with  caution  for  fear 
of  salivation.     (B.  H.) 

Ammoniated  Mercury: — 20  grains  to  4  drachms 
of  sulphur  ointment,  is  strongly  recommended  by 
Sir  William  Jenner. 

Chrysarobin: — Unna's  method  of  treatment  is  as 
follows :  1.  Cut  the  hair  close  over  the  whole  scalp. 
2.  Apply  a  protective  zone  of  zinc  paste,  extending 
for  a  short  distance  over  the  smooth  surface.  3. 
Then  apply  over  the  entire  scalp  the  following  oint- 
ment: chrysarobin,  5  to  10  per  cent.,  salicylic  acid,  2 
per  cent.,  ichthyol,  5  per  cent.  4.  Cover  this  w^ith 
some  impermeable  substance,  such  as  gutta  percha 
or  rubber.  A  flannel  bandage  or  close  cap  is  then  ap- 
plied. 5.  Remove  cap  or  bandage  once  in  twenty- 
four  hours,  loosen  dressing  on  one  side,  turn  it  over, 
and  apply  the  ointment,  then  seal  as  before.  6.  On 
the  fourth  day  the  chrysarobin  ointment  is  removed 
with  pledgets  of  cotton,  and  an  ichthyol  ointment,  5 
parts  to  100,  is  applied  dailj^  for  three  days.  On  the 
expiration  of  the  first  week  all  dressings,  including 
the  zinc  paste,  are  removed,  and  the  scalp  cleaned 
with  oil  and  soap.  The  whole  process  is  repeated  for 
another  week,  and  continued  until  cure  is  complete. 
This  method  is  highly  commended,  but  caution  is 
necessary  lest  too  active  inflammatory  disturbances 
are  produced ;  when  such  is  the  case,   suspend  the 


616  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

chrysarobin  and  cleanse  thoroughly  with  hot  water 
and  soap.     (Sh.) 

Carbolic  Acid: — One  of  the  most  effective  remedies  ; 
it  is  used  in  various  strengths  combined  with  glycer- 
ine, or  the  following,  suggested  hj  Alder  Smith,  which 
has  given  satisfactory  results : 

^.    Acid.  Carbolici  Cn^st., 

Ung.  Hydrarg.  Nitratis, 

Ung.  Sulphuris,  aa   ^  ss. 

M. 

Sig,  The  patches  should  be  rubbed  twice  a  day  and  the  entire 
scalp  once.     (Hy.) 

The  ingredients  are  mixed  without  heat.  The  oint- 
ment may  be  used  for  children  over  eleven  ^-ears  of 
age;  under  that  age,  increase  the  proportion  of 
sulphur  to  double  the  amount  or  even  more. 

The  following  combination  is  said  to  have  suc- 
ceeded when  carbolic  acid,  bichloride  of  mercury  and 
chrysarobin  have  been  used  for  four  months  without 
controlling  the  disease : 

5fe.    Acid.  Carbolici, 

Ol.  Petrolei,  aa  ^ij. 

Tr.  lodi, 

01.  Riciui,  aa  ^iiss. 

Ol.  Rusci  (German),  q.  s.  ad   Oj. 

M. 

Sig.  Apply  over  the  scalp  once  daily  for  four  successive  days, 
wash  off  with  green  soap  on  fifth  day.  Then  clip  the 
hair  close  and  wash  again  as  before.     (T.,  98. ) 

Copper  Oleate: — About  5J-iv-^  said  to  have  been 
efficient  even  in  the  most  obstinate  forms.     (N.) 

Formalin: — Pure  or  diluted,  gives  very  good  re- 
sults, though  its  pungent  odor  is  a  drawback.  (T., 
98.) 

Boric  Acid: — Useful  in  the  following: 


TRICHOPHYTOSIS— RINGWORM.  617 


«fc. 

Acid.  Borici, 

Etheris, 

Alcoholis, 

gss. 

M. 

(Ja.) 

Thymol: — Sometimes 

it  has 

proved  of  value 

,  and 

ay  be  combined 

as  follows : 

^. 

Thymoli, 
Chloroformi, 
01.  Olivae, 

3SS. 
3yj. 

M. 

( 

Pp.) 

Iodine: — The  tincture  is  one  of  the  best  remedies  in 
severe  cases,  painted  on  the  parts  twice  a  day.    (F.) 

Coster's  paste,  consisting  of  tr.  iodine  2  drachms, 
oil  of  cade  6  drachms,  is  useful  in  recent  cases.  Paint 
on  w^ith  a  brush.  In  a  few  days  remove  the  black 
crusts,  w^hich  form,  by  washing  with  soap  and 
w^ater;  then  reapply  the  paste.     (A.  W.) 

Hydrarg.  Bichlorid.: — An  effective  lotion  is  as  fol- 
lows: 

9;.     Resorcini,  gij. 

Hydrarg.  Bichlorid.,  gr.  iij-v. 

Glycerini,  gij. 

Alcoholis,  §vj. 
M. 

In  using  preparations  of  mercury  great  care  should 
be  observed  especially  in  infants  and  children  w^ith 
delicate  skins.     (B.  H.) 

Salicylic  Acid: — The  following  is  effective  :  The 
head  is  shaved  in  the  usual  way  for  at  least  an  inch 
beyond  the  margin  of  the  patch,  then  salicylic  acid 
in  collodion,  10  grains  to  the  ounce,  is  painted  on, 
extending  beyond  the  diseased  skin.  This  is  repeated 
daily  for  a  week ;  at  the  end  of  this  period  the  layer 
of  collodion  is  removed  by  lifting  it  w^ith  the  blade 


618  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

of  the  forceps  inserted  beneath  the  margin ;  the  sali- 
cyHc  acid  is  then  appHed  for  another  w-eek,  and  the 
same  process  of  removal  adopted,  and  repeated  until 
the  disease  is  eradicated.  Among  the  advantages  of 
this  method  is  the  prevention  of  the  access  of  spores 
to  other  parts.  A  solution  of  a  drachm  to  the  ounce 
of  distilled  vv^ater  is  also  used.     (Ck.) 

Nitrate  of  Silver: — Devergie  is  in  favor  of  applying 
a  strong  solution,  1  drachm  to  8  of  distilled  water. 
This  is  a  popular  remedy  both  for  ringworm  of  the 
head  and  body. 

Blistering: — In  very  chronic  cases  and  in  the  dis- 
seminated variety  this  is  sometimes  necessary.  For 
this  purpose  the  following : 

Cantharides  Collodion  (Squibb's)  or  Bichloride  of 
Mercury,  4  grains,  w^ith  Acetic  Acid,  1  ounce,  may 
be  used  for  producing  vesication.  These,  how^ever, 
are  too  strong  for  children  under  six  years  of  age 
and  for  delicate  or  strumous  persons.  The  crusts 
w^hich  form  in  a  few^  days  should  be  removed  and 
mild  soothing  dressings  applied,  such  as  liquor  car- 
bonis  detergens.  Croton  Oil  is  also  advocated,  but 
if  used  at  all  it  must  be  with  caution  and  on  limited 
areas,  as  it  may  cause  permanent  baldness.  1  part 
to  10  of  olive  oil  is  usually  strong  enough,  but  the 
strength  may  be  increased  until  a  mild  degree  of  pus- 
tulation  is  produced,  when  a  poultice  should  be  ap- 
plied and  the  loose  hairs  removed.     (B.  H.) 

Tar: — May  be  employed  in  the  form  of  the  officinal 
ointment  or  oil  of  cade,  or  combined  with  mercury 
and  sulphur,  as  follows : 

^.    Ung.  Picis  Liquidae, 

Ung.  Hydrarg.  Nitratis,  aa  ^ij. 

Ung.  Siilphuris,  3;iv. 

M.  (Pp.) 


TRICHOPHYTOSIS — RINGWORM.  619 

1^.    Liq.  Carbonis  Detergentis,  3J~ij- 

Hydrarg.  Aiiimoniati,  gr.  x. 

Lanolini  Conip.  Cum  Oleo,  ^j. 

M. 

This  forms  an  effective  and  an  agreeable  ointment 
suitable  for  very  young  children  and  persons  with 
delicate  skins.     (B.  H.) 

Sulphur: — The  officinal,  or  Wilkinson's  ointment, 
or  the  following  combination,  are  effective : 

9. 


Sulphur.  Praecipitati, 

33- 

Hydrarg.  Ammoniati, 

3SS. 

Thymoli, 

gr.  X. 

Vaselini, 

3J- 

Ung.  Simplicis, 

adgj. 

(A.W.) 

M. 

Naphthol: — A  1  per  cent,  solution  in  alcohol  is 
used,  or  the  follow^ing,  w^hich  is  recommended  by 
Kaposi : 

p.    Naphtholi,  3ss. 

Spts.  Sapo.  Viridis,  3J. 

Alcoholis,  3  XXV. 

Balsam.  Peruvian!,  3j- 

Sulphuris  lyoti,  5v- 
M. 

Sig.     Apply  twice  daily  for  two  or  three  days;  then  scrub  with 
green  soap. 

During  the  course  of  treatment  a  change  of  remedy 
will  often  prove  beneficial.  After  the  disease  has  been 
apparently  cured  it  w^ill  be  advisable  to  continue 
with  some  mild  parasiticide  application  for  a  short 
time. 

TRICHOPHYTOSIS  CORPORIS. 

In  selecting  a  parasiticide,  the  age  of  the  patient, 
as  well  as  the    severity  and  extent  of  the  lesion, 


620  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

should  be  taken  into  consideration.  It  may  be  ne- 
cessary to  remove  hairs  if  the  patient  is  very  hirsute. 
The  scales  must  first  be  w^ashed  oif  with  soap  and 
warm  v^ater,  then  some  slightlj^  irritating  and  as- 
tringent, or  some  antiparasitic  application,  will  in 
most  cases  readily  effect  a  cure. 

For  infants:  Resorcin,  gr.  xv-xx,  to  alcohol  or 
vaseline,  5J.  (B.  H.)  For  adults  and  older  children 
an  ointment  of  Oleate  of  Copper,  gr.  v-xx-§j,  in- 
creased if  necessary.  (Sm.)  Ammoniated  Mercury, 
gr.  xv-xl-5j.  (Vn.)  Ichthyol,  gr. x-xxx-gj.  (B.  H.) 
Sulphate  of  Quinine,  5  per  cent.  (F.)  Salicylic 
Acid,  10  to  20  per  cent,  ointment,  used  daih^  in  con- 
junction with  weekly  applications  of  a  Bichloride  of 
Mercury  lotion.  Carbolic  Acid,  3J-5J,  of  glycerine. 
(B.)    (Ja.) 

Hydrarg.  Bichlorid.: — Gr.  ij— iv,  to  the  ounce  of 
alcohol  or  w^ater,  or  a  solution  of  10  grains  to  the 
drachm,  retained  in  place  for  a  few  minutes  only. 
(And.) 

Benzoin: — The  compound  tincture  painted  on  once 
a  week  is  effective.     (Ja.) 

Chrysarobin: — Gr.  x-xxx-§j,  suspended  in  flexible 
collodion  or  traumaticin,  is  excellent,  but  should  not 
be  used  in  cases  of  infants  or  about  the  face.    (B.  H.) 

The  following  is  efficient  in  obstinate  forms  located 
on  the  thighs  and  groins : 

9. 


Creosoti, 

M.x 

01.  Cadini, 

Sulphuris, 

aa  3iij 

Potass.  Bicarbonatis, 

3j- 

Adipis, 

SJ. 

M.  (Vn.) 

Should  remedies  of  this  class  fail,  blistering  fluids 


TUBERCULOSIS.  621 

may  be  applied :  Smith's  Emplastrum  Cantharidis 
Liquidi  is  good;  also  Acetum  Cantharadis,  pre- 
pared with  glacial  acetic  acid.  It  should  be  painted 
on  the  eruption  with  a  small  brush.  One  application 
is  usually  sufficient ;  but  if  not,  repeat  in  a  few^  days. 
There  are  numerous  other  remedies,  such  as  Sul- 
phurous Acid,  Acetic  Acid,  Sodium  Sulphite,  etc., 
all  of  which  will  be  found  of  service.  To  prevent  re- 
lapse, or  the  spread  of  contagion,  the  clothing  should 
be  boiled,  baked,  or  in  some  way  disinfected. 


TUBERCULOSIS. 

TUBERCULOSIS  OF  THE  LARYNX. 

The  important  indications  of  treatment  are  relief 
of  the  dysphagia,  the  dyspncea,  and  the  ulceration. 
Deep  ulcers  are  most  effectively  and  speedily  treated 
by  surgical  means ;  in  rare  cases  cured ;  in  many 
cases  relieved. 

Local  treatment  should  be  preceded  by  cleansing 
sprays,  such  as  Boric  Acid,  Borax  or  Salt,  gr.  x-§j. 
Thorough  cleansing  is  also  essential  in  order  to  limit 
the  irritating  action  of  the  sputum. 

Lactic  Acid: — Nov^^  accepted  by  most  observers  as 
one  of  the  best  topical  remedies.  Even  in  the  most 
unfavorable  cases  it  will  relieve  dysphagia.  The 
strength  of  the  application  may  vary  from  10  per 
cent,  to  the  pure  acid.  It  is  advisable  to  begin  with 
a  weak  solution,  as  the  healthy  mucous  membrane, 
if  involved  in  the  application,  may  become  highly  ir- 
ritated.   When    hardened    infiltrations  are  present, 


622  DIGEST    OF   EXTERNAL  THERAPEUTICS. 

curettage  or  scarification  should  precede  the  applica- 
tion. The  acid  acts  quickly  on  soft  ulcerations  and 
with  especial  rapidity  on  ulcerated  surfaces.  Appli- 
cations should  be  made  daily  with  a  brush;  then 
every  other  da3\  Laryngeal  spasm  and  a  sense  of 
burning  may  follow,  but  these  conditions  may  be  re- 
lieved hj  cocaine  in  10  to  15  per  cent,  solutions.  ( Al.) 

Curettement: — This  measure  is  analogous  to  ex- 
cision for  the  removal  of  the  focus  of  infection ;  fol- 
lowed by  lactic  acid  applications,  it  has  proved 
highly  beneficial.  Indications  —  1.  Primary'  disease 
without  pulmonary  infection.  2.  Cases  w^ith  con- 
comitant lung  disease  incipient  or  nrrested  before 
softening  or  hectic.  3.  Circumscribed  ulcerations  and 
infiltrations.  4.  Dense,  hard  sw^elling  of  arytenoid  re- 
gion, tuberculous  tumors,  affections  of  epiglottis.  5. 
Advanced  lung  disease  with  distressing  dyspnoea. 

Absolute  rest  after  the  operation  must  be  enjoined, 
w^ith  daily  applications  of  Lactic  Acid  and  Pyoktanin 
1  to  2  per  cent.  Cicatrization  is  usual  in  from  one 
to  four  weeks.     (L.  B.) 

Ichthyol: — Applied  pure  after  curettement  has  suc- 
ceeded w^hen  the  operation  followed  by  lactic  acid 
has  failed.     (Sj.) 

Guaiacol: — Affords  great  relief,  applied  pure  after 
lactic  acid  applications  following  curettement.  Also 
in  form  of  a  20  per  cent,  spray.     (T.,  97.) 

Chromic  Acid : — A  3  per  cent,  solution  acts  well  in 
superficial  ulcerations.     (T.,  96.) 

Lacto-Carbolized  Glycerine: — The  following  is 
claimed  to  form  a  superior  application : 

Lactic  Acid,  3ss. 

Neutral  Glycerine,  ^v. 

Carbolic  Acid,  M.xv. 


TUBERCULOSIS.  623 

As  tolerance  increases,  the  strength  of  the  two 
acids  is  also  increased  two  to  four  times.     (Sj.) 

Monochlorphenol: — 5  per  cent,  solution  in  light 
petroleum  oils  or  glycerine,  is  palliative  in  action. 

Parachlorphenol: — Mixed  with  glycerine  in  vari- 
ous proportions  form  a  soothing  application.  Re- 
port of  10  cures  out  of  26  cases.     (Sj.) 

Airol : — By  insufflation,  superior  to  iodoform  or 
aristol.     (T.,  98.) 

Balsam  Peru: — As  an  inhalant,  10  parts  to  5  of 
alcohol,  20  to  30  drops  in  a  pint  of  boiling  water. 
(Al.) 

Resorcin  : — Daily  application  of  an  80  per  cent,  so- 
lution for  ulcerative  stage.     (Al.) 

Iodoform: — For  constitutional  effects  this  remedy 
may  be  administered  by  inunction  as  mentioned  un- 
der Pulmonary  Tuberculosis.  As  a  local  remedy  it 
exerts  a  retarding  influence  upon  the  disease  and  is 
indicated  at  any  stage,  but  appears  to  yield  the  best 
results  in  superficial  ulcerations  of  the  arytenoid 
masses.  It  is  usuall3'  employed  pure  by  insufflation. 
A  small  proportion  of  morphine  may  be  added  ad- 
vantageously. For  an  astringent  stimulant  effect  the 
following : 


¥t. 

lodoformi, 
Bismuth.  Subnitratis, 

gr.l. 

Benzoin.  Res., 

aa  gr.  xxxv. 

M. 

(Ing.) 

¥t. 

Acid.  Borici, 

lodoformi, 

aa  3j. 

M. 

Pyoktanin: — Probes  heated,  dipped  in  the  powder 

and  rubbed  on  the  ulcers  promote  cicatrization.  (Al.) 

Creosote: — Inhalations  or  sprays  of  this  remedy 


624  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

are  generally  contra-indicated  when  there  is  a  ten- 
dency to  hasmorrhage  and  by  high  temperatures ;  if 
used  under  these  conditions  caution  must  be  ob- 
served. 

The  following  are  convenient  formul£e : 

For  inhalation : 

^.    Creosoti,  M.lxxx. 

Magnesiae,  Carbonatis,  gr.  xxv-xl. 

Aquae,  ^j. 

M. 
Sig.     A  teaspoonf ul  to  a  pint  of  water.  (Leflferts. ) 

T^.    Creosoti, 

Chloriformi, 

Alcoholis,  partes  equales. 

M. 
Sig.     A  few  drops  on  a  sponge. 

For  a  spray : 
9;.    Creosoti,  M.ij. 

Mentboli,  gr.  iv. 

Alboleni,  ^j. 

M. 
Sig.     Use  with  an  atomizer  several  times  a  day.  (F. ) 

Terebene : — 5  to  40  minims,  to  w^ater  1  ounce, 
with  about  20  grains  of  magnesia  carbonate.  Dis- 
solve a  teaspoonful  of  the  mixture  to  a  pint  of  -water 
and  inhale  the  vapor  at  a  temperature  of  140°  for 
ten  minutes  night  and  morning.     (F.) 

Cocaine : — For  the  relief  of  pain  and  dysphagia.  A 
simple  4  per  cent,  solution  as  a  spray  (Os.),  or  the 
following : 

Hydrochlorate  of  Cocaine,  gr.  iv. 

Hydrochlorate  of  Morphine,  gr.  ij. 

Antipyrin,  3ss. 

Cherry  Laurel  Water  (made  by  distilla- 
tion). 

Sterilized  Water,  aa  §ij. 
From  2  to  4  teaspoonfuls  by  atomization  every  twenty -four  hours. 


TUBERCULOSIS.  625 

Hydrochlorate  of  Cocaine,  gr.  iij. 

Sugar  of  Milk, 

Gum  Arabic,  Powdered,  aa  3j- 

Make  into  a  very  fine  powder  and  apply  by  insufflation.  (T., 
97-) 

For  other  remedies  for  the  relief  of  dysphagia  see 
that  subject. 

Formaldehyde: — Solution  of  1  to  10  per  cent, 
highly  endorsed.  Cocainization  is  necessary  after 
using  on  account  of  the  intense  smarting ;  a  20  per 
cent,  cocaine  solution  may  be  necessary  after  the 
stronger  solution.     (T.,  98.) 

Sodium  Formate: — Has  proved  of  great  service; 
may  be  used  in  solutions  of  5  to  20  grains  to  half  an 
ounce  each  of  glycerine  and  water,  or  an  ounce  of 
v^^ater  alone.  As  an  insufflating  powder  it  is  com- 
bined with  starch,  1  part  to  4  of  starch.  This  is 
blown  on  the  ulcerated  spots  only.  As  a  pigment  it 
is  employed  in  advanced  cases  in  the  strength  of  40- 
60  grains  to  the  ounce.     (F.) 

Ligno- Sulphite: — By  inhalation,  10  to  30  per  cent, 
solution,  relieves  cough  and  dysphagia  and  improves 
the  ulcers.     (T.,  98.) 

Hydrarg.  Bichlorid.: — Recommended  as  a  spray  as 
follows : 

9^.    Hydrarg.  Bichlorid.,  gr.  iv. 

Ammon.  Chloridi,  gr.  x. 

Glycerini,  gij. 

Aquae,  ^  viij. 
M.  (Al.) 

For  submucous  injection  when  there  is  local  tume- 
faction w^ithout  ulceration  the  following : 
Pyoktanin,  2  per  cent,  solution. 
Aristol,  2  per  cent,  solution. 

41 


626         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Phenazonum,  50  per  cent,  solution.     (T.,  96.) 
For  intra- tracheal  injection : 

9:.    Camphorse, 

Mentholi,  aa  gr.  v. 

Alboleni,  ^j. 

M.  (T.,  98.) 

TUBERCULOSIS  OF  THE  LUNGS. 

Iodoform  Inunction: — This  method  was  introduced 
in  the  Metropolitan  Hospital,  Blackwell's  Island,  by 
Dr.  W.  B.  Keiser,  of  the  House  Staff,  with  the  ap- 
proval of  the  author.  The  following  ointment  is 
carefully  prepared : 

9:.    lodoformi,  ^  ss. 

01.  Anisi,  M.x-xxx. 

01.  Gaultherae,  3ij. 

01.  Olivae, 

Lanolini,  aa  ^v. 

M. 

This  is  administered  in  the  same  manner  as  mer- 
curial inunctions ;  that  is,  rubbing  the  flexor  surface 
of  one  arm  one  day,  that  of  another  the  next,  then 
the  chest,  abdomen,  back,  etc.  After  the  different 
surfaces  have  had  the  inunction  applied,  the  process 
is  repeated  and  kept  up  until  there  is  some  indication 
of  change.  The  author  has  observed  good  effects 
from  this  method  and  no  bad  results. 

Europhen: — This  remedy  has  been  used  as  a  sub- 
stitute for  iodoform  in  the  treatment  of  tuberculosis 
by  inunctions.    It  is  employed  as  folio w^s : 

T^.    Europhen.,  5J- 

01.  Rosae,  gtt.  j. 

01.  Anisi,  5j- 

01.  Olivse  vel  Lanolini,  ^i\ss. 

M. 

Sig-      3  3  to  5ss  rubbed  into  the  axilla  and  inside  of  the  thighs 
once  or  twice  a  day. 


TUBERCULOSIS.  627 

The  remed}'  should  be  continued  for  a  long  time 
after  disappearance  of  symptoms.  Results  have 
proved  its  value.     (Pa.  M.  J.,  10,  99.) 

Inhalations. 

Creosote  : — Lessens  expectoration  and  deodorizes, 
but  contra-indicated  when  there  is  tendency  to  haem- 
orrhage, viz.: 

9;.    Creosoti, 

Ethyl.  lodidi, 

Terebenis,  Partes  equales. 

M. 
Sig.     lo  to  2o  drops  in  inhaler. 

^.    Creosoti, 

Eucalyptoli, 

Terebenis,  Partes  equales. 

M. 
Sig.     lo  to  20  drops  in  inhaler. 

J^.    Creosoti, 

Thymoli, 

Alcoholis,  Partes  equales. 

M. 
Sig.     ID  to  20  drops  in  inhaler.     (Sm.) 

Thymol: — The  following  formula  suggested  by  Dr. 
C.  C.  Rice  is  useful : 

^.    Mentholi, 

Thymoli, 

Acid.  Carbolici,  aa  gr.  v. 

Ol.  Eucalypti,  gij. 

Ol.  Pini  Silvestris,  giij. 

M. 

Sig.     A  teaspoonful  to  a  pint  of  boiling  water  and  the  vapor 
inhaled,  or  20  to  30  drops  inhaled  from  cotton. 

Eucalyptus: — The  oil  poured  on  boiling  water,  or 


628  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

eucalyptus  water  in  a  steam  atomizer,  when  expec- 
toration is  fetid.     (Sm.) 

Terebene: — Less  active  than  other  agents  as  a 
germicide,  but  more  stimulating ;  useful  in  combina- 
tion w^itli  other  remedies. 

Tr.  Benzoin  Comp.: — 1  drachm,  to  a  pint  of  boiling 
water.     (Ing.) 

Tar  Water: — Heated,  and  the  fumes  inhaled.     (F.) 

Iodoform: — 4  per  cent,  solution  in  turpentine,  or  1 
drachm  to  turpentine  1  ounce ;  3  to  4  drops  at  high 
temperature.     (Sm.) 

Iodine: — Sometimes  used,  viz.: 

Sol.  Iodine  (Iodine,  Potass.  Iodide,  each 

gr.  iij,  Alcohol,  3j),  HJ-iv. 

Water,  ^  v 

Place  in  a  suitable  inhaler  and  expose  to  heat. 

Tr.  Conium  may  be  added  to  lessen  its  irritating 
qualities.     (F.) 

Ethyl  Iodide: — This  will  give  the  effect  of  iodine 
combined  with  a  sedative  action.  It  may  be  inhaled 
directly  from  a  vial  or  dripped  upon  the  sponge  of 
Yeo's  perforated  zinc  respirator.  The  frequency  of 
its  administration  will  depend  upon  the  severity  of 
the  case,  and  its  duration  upon  the  immediate  effects 
shown.  Vertigo  will  be  produced  if  inhaled  too  long. 
The  average  time  is  five  minutes,  the  average  fre- 
quency six  times  a  day.     (F.) 

Turpentine: — The  following  is  a  formula  for  in- 
halation : 

9;.    Terebinthinse,  gtt.  j-v. 

Glycerini,  3J- 

Aquae,  gj. 
.M.  (F.) 


TUBERCULOSIS.  629 

Peppermint: — A  method  of  use  as  follows :  Fasten 
on  the  nostrils  a  piece  of  linen  folded  once ;  on  this  a 
few  drops  of  essence  of  peppermint  are  poured.  The 
nostrils  should  previously  be  greased  to  avoid  irrita- 
tion, then  the  patient  should  take  eight  or  ten  deep 
inspirations  with  closed  mouth,  repeating  the  pro- 
cedure every  fifteen  minutes  for  a  time.    (Sj.) 

Guaiacol: — The  following  is  to  be  used  for  impreg- 
nating the  atmosphere  of  the  room  : 

9;.    Guaiacoli,  ^iss. 

Eucalyptoli,  EiZ'^l 

Acid.  Carbolici,  Jj. 

Mentholi,  3  v. 

Thymoli,  ^iiss. 

Ess.  Caryophylli,  3J  M.xv. 

Alcoholis  (at  90°),  q.  s.  ad  Oij. 

M. 

An  ounce  of  this  is  placed  in  the  bottle  of  the  large 
atomizer  of  Lucas  Championniere,  the  bottle  of 
which  is  two-thirds  full  of  water.  This  is  sprayed 
in  the  patient's  room  for  tw^o  hours  daily,  and  is 
claimed  to  form  an  important  adjunct  of  treatment. 
<Sj.) 

Sprays. 

Serve  to  cleanse  and  deodorize  the  pharynx  and 
upper  respiratory  tract,  and  assist  in  relieving  dys- 
phagia and  other  distressing  throat  symptoms. 
The  follow^ing  may  be  used : 

Guaiacol: — Especially  eflftcacious  as  a  deodorant 
in  all  forms  of  tuberculous  catarrh ;  1  part  to  600  of 
water.     (F.) 

Hydrogen  Peroxide: — 1  part  to  8;  stronger  if  de- 
sired, repeating  applications  until  froth  has  been 
wr ashed  aw^ay. 


630         DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Cocaine: — In  solutions  as  mentioned  for  tuberculo- 
sis of  the  larynx  and  for  relief  of  dysphagia.     (An. ) 

Formalin : — Recommended  as  a  spray  inhalation  in 
early  stages,  viz.: 

9^.    Formalini,  3J. 

Glycerini,  .  ^iv. 

Aq.  Destill.,  gv. 

M. 

Sig.     Use  four  or  five  times  a  day  for  ten  to  fifteen  minutes  at 
a  time.     (L.,  8,  19,  99.) 

Creosote: — Contra-indicated  when  there  is  a  ten- 
dency to  haemorrhage ;  may  be  combined  as  follows : 

Jfc.    Creosoti,  3J. 

Tr.  Benzoin.  Comp.,  gij. 

Destill.  Hamamelidis, 

Aquae, 

Glycerini,  aa  5^ss. 

M.  (Sm.) 

The  follow^ing  in  the  proportion  of  the  amount 

mentioned  to  an  ounce  of  w^ater  are  also  used : 

Boric  Acid,  gr.  x  to  xx. 

Chlorine  ^A^ater,  3J. 

Potass.  Permang.,  gr.  j  to  viij. 

Sulphurous  Acid,  M.x  to  5J. 

Lactic  Acid,  M.vj  to  3J. 

Oil  of  Turpentine,  M.  j,  with  glycerine,  5J. 

Salicylic  Acid,  gr.  v. 


Guaiacol: — The  following  combination  w^ith  men- 
thol is  used  for  tracheal  injection,  viz.: 

Guaiacol,  2  per  cent. 

Menthol.  10  per  cent. 

Olive  Oil,  88  per  cent. 

1  to  2  drachms  are  rapidly  injected  during  inspira- 
tion.    Coughing  may  be  avoided  by  quickly  passing 


TUBERCULOSIS.  631 

the  nozzle  of  the  syringe  through  the  rima  glottidis 
and  injecting  into  the  trachea.  It  is  claimed  there  is 
no  discomfort,  and  that  the  relief  of  the  dyspnoea  is 
marked.     (Sj.) 

Guaiacol  may  also  be  administered  by  rectal  in- 
jection. Milk  forms  an  excellent  excipient  for  this 
purpose ;  dissolve  1  part  in  from  20  to  30  of  milk. 
The  solution  keeps  indefinitely,  and  readily  mixes 
with  water. 

For  the  chest  pains  which  accompany  advancing 
tuberculosis,  the  various  mildly  counter-irritant  and 
soothing  liniments  and  embrocations  will  assist  as 
palliatives.  For  the  dyspnoea  the  following  rubbed 
on  the  chest  may  be  employed  : 

Croton  Oil,  i  part. 

Oil  of  Cajuput, 

Alcohol,  each  3^  parts. 

(Al.) 

To  relieve  neuralgia  in  phthisical  patients  the  fol- 
low^ing  ointment  w^ill  prove  useful : 

|fc.    Guaiacoli, 

Methyl.  Salicylatis,  aagr.  Ixxx. 

Ext.  Belladonnae,  gr.  iiiss 

Ext.  Opii,  gr.  iv. 

Vaselini, 

Lanolini,  aa  5ss. 

M. 

Sig.  A  very  small  quantity  is  lightly  applied  and  the  part 
covered  with  some  impermeable  material  and  absorbent 
cotton . 

The  application  must  be  discontinued  as  soon  as 
the  skin  becomes  even  slightly  reddened.  In  very 
acute  cases  menthol,  15  grains,  or  antipyrine,  30  to 
45  grains,  or  bromide  of  potassium,  80  grains,  may 
be  added.     (T.  P.,  9,  99.) 


632         DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Sometimes  an  anodyne  gargle  will  be  found  to 
afford  relief  to  the  cough  and  throat.  For  this  pur- 
pose the  following  are  suggested : 

9;.    Tr.  Opii  Camphoratae, 

Tr.  Benzoin.  Comp., 

Tr.  Kino,  aa  ^j. 

M. 
Sig.     Dilute  with  water  and  gargle, 

9;.    Tr.  Opii  Camphoratae, 

Aq.  Menthae  Pip., 

Glycerini,  aa  ,^j. 

M.    ■  (Sm.) 

Sig.     Dilute  with  water  and  gargle. 

Nitrate  of  Silver  Injections  over  the  Course  of  the 
Vagi: — Acting  on  the  theory  that  the  primary  mor- 
bid processes  in  pulmonary  phthisis  are  fundamen- 
tally dependent  on  a  neurotic  base  in  which  the  vagi 
are  seriously  involved,  Dr.  T.  J.  Mays,  of  Philadel- 
phia, has  employed  this  treatment  w^ith  success. 
During  the  last  year  he  reports  that  he  has  given 
more  than  two  thousand  injections.  The  cases  were 
of  all  stages  of  the  disease,  incipient,  advanced  and 
far  advanced.  The  cough  and  expectoration  were 
lessened  and  the  general  condition  of  the  patient  im- 
proved. The  best  results  were  obtained  in  incipient 
cases.  From  4  to  7  minims  of  a  2.5  per  cent,  solution 
of  pure  nitrate  of  silver  (Merck's)  were  found  to 
answer  best  in  most  instances,  although  a  5  per 
cent,  solution  w^as  required  in  some  cases  to  bring 
about  the  desired  inflammatory  reaction. 

The  point  of  injection  is  over  or  slightly  beyond 
the  carotid  artery  in  the  region  of  the  neck,  midv^ay 
between  the  angle  of  the  jaw  and  clavicle.  Caution 
must  be  observed  not  to  puncture  the  carotid  artery 


TUBERCULOSIS.  633 

or  jugular  vein  ;  to  avoid  this  accident  lift  the  skin  be- 
tween the  thumb  and  finger  of  the  left  hand  and  in- 
troduce the  needle  under  the  elevated  skin.  Con- 
siderable pain  is  produced  which  may  be  avoided  by 
a  previous  injection  of  5  minims  of  a  2.5  per  cent, 
solution  of  cocaine. 

The  most  practical  plan  for  the  administration  of 
this  remedy,  according  to  Dr.  Mays,  is  as  follows : 

"Inject  the  cocaine  solution,  detach  the  syringe 
from  the  needle  and  let  the  latter  remain  in  the  punc- 
ture. Wash  out  the  syringe  with  water,  draw  the 
silver  solution  into  the  syringe,  attach  the  latter  to 
the  needle  and  throw  in  the  required  amount. 

"The  local  visible  effects  of  the  injections  show 
themselves  in  nodular,  sometimes  in  diffuse  swelling, 
and  in  redness  and  pain;  but  in  no  instance  have 
these  products  become  extremely  pronounced.  Small 
abscesses  have  occurred  about  a  dozen  times,  and  a 
slough  once  in  about  three  hundred  injections,  two  of 
these  being  produced  by  using  too  strong  a  solution 
of  silver  in  the  early  stage  of  the  experiment.  Neither 
the  rupture  and  discharge  of  the  abscesses,  nor  the 
small  slough  in  one  instance,  had  any  detrimental  in- 
fluence on  the  patients." 

"The  number  of  injections  necessary  depends  on 
circumstances.  As  a  rule,  it  is  a  good  plan  to  begin 
by  giving  one  injection  on  the  side  of  the  neck  on 
w^hich  the  affected  lung  is  situated.  In  a  week  or  ten 
days  this  is  to  be  repeated,  unless  the  original  or  pre- 
vious injection  is  followed  by  too  much  irritation. 
In  urgent  cases  due  to  excessive  coughing  I  have  re- 
peated the  injections  in  three  or  four  days.  As  a  rule, 
it  seems  best  to  concentrate  the  injections  on  the 


634  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

aJBfectQd  side  and  to  give  an  occasional  one  on  the 
opposite  side."     (P.  M.  J.,  2,  11,  99.) 

In  a  subsequent  article  on  the  subject  Dr.  Mays 
says:  That  the  side  of  the  neck  in  which  the  injec- 
tion accomplishes  its  best  work,  varies  in  different  in- 
dividuals, and  even  in  the  same  individual  at  differ- 
ent periods,  and  cannot  always  be  readily  deter- 
mined in  advance.  While  it  is  a  good  plan  to  give 
most  of  the  injections  on  the  same  side  of  the  neck 
below  which  the  infected  lung  is  located,  this  being  a 
general  rule  to  follow^  throughout  in  some  cases,  it 
will  be  found  in  others  that  in  time  the  injections  be- 
come unserviceable  on  that  side,  and  give  better 
result  on  the  opposite  side  of  the  neck.  (P.  M.  J.,  12, 
30,  99.) 

Antiphthisin: — This  is  an  sozalbumin  isolated  by 
Klebs  from  cultures  of  the  tuberculous  bacilli.  Klebs 
maintained  that  the  remedy  w^as  entirely  destitute 
of  the  toxic  properties  of  tuberculin,  the  alkaloids 
and  toxalbumins  of  w^hich  were  eliminated.  In  from 
80  to  90  per  cent,  of  a  series  of  cases  of  pulmonary 
tuberculosis,  the  administration  of  the  remedy  was 
attended  w^ith  improvement,  and  in  the  early  stages 
the  disease  w^as  arrested  and  apparently  cured.  Anti- 
phthisin is  usually  given  hypodermically ;  the  dose 
for  adults  should  commence  with  one-tenth  of  a  c.c, 
to  be  increased  daily  by  the  same  amount  until  five- 
tenths  have  been  reached.  This  may  be  repeated  for 
several  days  or  a  week,  and  again  increased  by 
tenths  as  heretofore.  When  1  c.c.  has  been  reached, 
repeat  this  dose  for  a  week  or  more,  and  when  dis- 
tinct improvement  is  manifest,  as  is  usually  the  case, 
this  dose  may  be  continued  for  a  longer  period.  It  is 
rarely  necessary    to    exceed    2  c.c,  although    much 


TUBERCULOSIS.  635 

larger  doses  are  well  tolerated  without  producing 
disagreeable  symptoms.  The  remedy  may  be  con- 
tinued in  doses  of  1  to  2  c.c,  according  to  the  results 
obtained  and  the  character  and  stage  of  the  disease, 
for  several  months,  w^hen  it  may  be  intermitted,  espe- 
cially if  the  results  are  such  as  to  point  to  the  entire 
arrest  of  the  malady.  But  even  in  these  cases  and  in 
those  w^here  all  symptoms  have  disappeared,  it  is 
well  to  repeat  the  series  of  injections  after  an  inter- 
val of  one  or  more  months,  during  w^hich  time  the 
patient  should  be  kept  under  observation.  As  much 
as  10  c.c.  given  daily  for  several  weeks  has  been  used ; 
it  has  also  been  administered  by  rectal  injection. 
It  is  recommended  only  in  the  earlier  stages  of  the 
tuberculous  process.  When  larger  amounts  than  1 
c.c.  are  given,  the  dose  should  be  divided — one-half 
being  administered  in  the  morning  and  the  other  at 
night.  If  local  irritation  is  produced,  the  medica- 
ment may  be  diluted  with  a  small  quantity  of  dis- 
tilled water  and  injected  in  the  rectum. 

Maragliano's  Serum: — This  was  obtained  from  the 
dog,  the  ass  and  the  horse,  and  was  presumed  by  its 
discoverer,  Maragliano,  of  Genoa,  to  contain  a 
tuberculous  antitoxin.  He  recommends  that  1  c.c. 
should  be  injected  systematically  every  tw^o  days. 
He  first  began  with  double  the  dose,  but  found  that 
the  smaller  amount  was  sufficient.  In  continuous 
fevers,  with  persistent  high  temperature,  as  much  as 
5  and  even  10  c.c.  may  be  injected  in  one  dose,  re- 
peating in  from  five  to  eight  days,  and  so  on,  when 
after  two  or  three  days  an  impression  will  be  found 
to  have  been  produced  in  the  patient's  temperature. 
Maragliano  sums  up  the  following  results  from  his 
statistics:   "1.   The  remedy  has  been  proved  to  be 


636  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

quite  innocuous.  2.  It  has  caused  subsidence  of 
fever.  3.  It  has  had  a  modifying  influence  on  the 
morbid  local  processes.  4.  It  has  caused  the  bacilli 
in  the  sputum  to  diminish  in  number  or  entirely  dis- 
appear. 5.  It  has  brought  about  a  notable  increase 
of  weight.  6.  It  has  had  a  beneficial  effect,  more  or 
less  marked,  according  to  the  gravity  of  the  disease, 
in  91.79  per  cent,  of  the  cases.  7.  It  has  cured  or 
put  on  the  road  to  cure  nearly  all  the  patients  with 
circumscribed  non-febrile  forms  of  the  disease.  8.  It 
has  even  cured  cases  in  which  cavities  had  formed. 
9.  It  may  be  used  to  advantage  in  all  forms  of  tuber- 
culosis." 

Tuberculin: — A  careful  study  of  the  results  ob- 
tained by  the  use  of  this  remedy  in  tuberculosis  has 
led  to  the  general  conviction  that  its  benefit  is  not 
only  doubtful,  but  that,  unless  it  is  employed  with 
discretion  and  care,  harm  maj'  follow  its  administra- 
tion. 

In  regard  to  the  administration  of  tuberculin  the 
dose  varies  according  to  different  observers.  It  is 
advised  that  an  injection  should  not  be  repeated 
until  twenty-four  hours  after  all  signs  of  irritation 
from  the  previous  dose  has  disappeared. 

According  to  Drs.  Grasset  and  Vedel  the  remedy 
has  fallen  undeservedly  into  disrepute,  ov^ing,  it  is 
claimed,  to  the  fact  that  probably  too  large  doses 
have  been  emplo3'^ed,  the  most  serviceable  dose  being 
from  two-tenths  to  three-tenths  of  a  milligram  for 
the  first,  and  a  half  a  milligram  for  the  second  injec- 
tion. From  experiments  on  fourteen  cases,  these 
writers  arrive  at  the  following  conclusions:  1.  In 
doses  as  above  stated  the  remedy  is  quite  harmless 
and  there  is  no  risk  of  aggravating  an  existing  tuber- 


TUBERCULOSIS.  637 

culosis.  2.  In  certain  cases  the  action  was  sufficient 
to  make  a  diagnosis  of  tuberculosis.  3.  In  two  cases 
the  reaction  was  doubful  or  absent.  4.  Absence  of  re- 
action was  found  not  to  exclude  the  presence  of 
tuberculosis,  since  there  was  none  in  three  cases. 
This  is  explained  on  the  supposition  that  the  organ- 
ism had  become  accustomed  to  the  toxin,  when  these 
small  doses  would  be  ineffectual.  5.  One  case  showed 
a  slight  reaction.     (T.,  97.) 

Another  plan  of  administration  is  as  follows :  For 
"Tuberculin  Koch"  for  diagnostic  purposes  give  i^ 
to  1  milligram  for  the  initial  dose,  2  milligrams  for 
the  second,  4  or  5  milligrams  for  the  third,  and  10 
milligrams  for  the  fourth  dose.  An  interval  of  three 
to  seven  daj'S  should  be  allowed  between  the  injec- 
tions. If  the  patient  reacts  to  any  one  or  all  of  these 
injections,  he  should  be  considered  tuberculous.  An- 
other method  is  to  begin  with  5  milligrams  for  first 
dose,  10  milligrams  for  the  second,  and  25  milli- 
grams for  the  third.  Finally,  some  physicians  use 
but  one  injection,  and  that  of  10  milligrams. 

Previous  to  the  injection  the  morning  and  evening 
temperature  of  the  patient  should  be  taken  for  two 
or  more  daj-s.  If  there  shall  be  one  or  two  degrees 
above  the  normal,  tuberculin  should  not  be  used. 
The  temperature  should  be  taken  every  two  hours 
for  the  first  six  hours  after  injection,  and  then  every 
hour  for  six  hours  until  a  period  of  twelve  hours 
has  passed  after  the  injection. 

A  reaction  is  said  to  have  taken  place,  when  the 
patient  develops  v^ithin  twelve  hours  a  rise  in  tem- 
perature of  from  one  and  one-half  to  two  degrees  or 
more  above  the  mean  temperature  previous  to  the 
injection.     Headaches,  malaise,  and  anorexia,  occa- 


638  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

sionally  vomiting  and  pain  in  the  chest  may  follow 
the  injection.  Sibilant  and  moist  rales  will  be  heard 
in  increased  number  over  the  involved  area  of  the 
lung.  The  urine  may  be  more  copious,  with  lowered 
specific  gravity. 

"Tuberculin  New  Koch"  should  be  given  in  initial 
doses  of  -^Itj  milligram.  It  should  be  first  diluted  with 
an  0.6  per  cent,  sterilized  solution  of  common  salt. 
0.1  c.c.  of  "tuberculin  new"  is  added  to  a  sterilized 
solution  of  salt  to  500  cc,  1  c.c.  of  the  solution  will 
represent  - ^^  milligram  of  tuberculin ;  this  is  regarded 
as  the  proper  dose  w^ith  w^hich  to  begin.  The  injec- 
tion should  be  made  every  second  day,  at  first,  and 
the  quantity  gradually  increased  until  5  milligrams 
are  given;  but  this  dose  (5  milligrams)  should  not 
be  given  oftener  than  twice  a  week.  The  dose  may 
be  increased  up  to  20  milligrams  bj^  degrees,  and  if 
no  reaction  occurs  it  may  be  discontinued  or  given 
at  greater  intervals.  Avoid,  if  possible,  a  higher  rise 
in  temperature  than  one-half  degree. 

Carbolic  acid  or  similar  agents  should  not  be  used 
when  making  the  solutions  of  tuberculin,  and  solu- 
tions of  the  remedy  should  not  be  administered  after 
theyjiave  become  turbid  or  cloudy  in  appearance. 
(T.  P.,  1,1900.) 

Physical  Exercise: — Treatment  and  prophylaxis 
by  lung  gymnastics  form  a  valuable  adjunct  when 
vital  capacity  is  low  aud  chest  expansion  limited. 
Forcible  expansion  of  the  apex  will  be  found  useful  in 
incipient  cases.     (Sj.) 

Respirator}'  Differentiation  Therapy  with  the 
Pneumatic  Cabinet: — The  more  general  adoption  of 
this  method  for  the  treatment  of  diseases  of  the 
lungs  is  urged  b3'  Solis  Cohen.    Inspiration  of  con- 


TUBERCULOSIS.  639 

densed  air  and  expiration  into  rarefied  air  alone  or 
in  combination  are  the  expedients  generallj^  em- 
ploj^ed,  viz.: 

Inspiration  of  Condensed  Air : — Indicated  in 
chronic  pulmonary  tuberculosis  at  any  stage  of  gen- 
eral softening  with  cavities,  but  particulary  in  the 
early  stages  when  deficient  respiration,  anaemia, 
poor  circulation  and  digestive  disorders  suggest 
tuberculosis,  even  in  the  absence  of  pronounced  phy- 
sical signs  and  of  bacilli  in  the  sputum.  In  such  cases 
it  ma3"  be  employed,  in  place  of  change  of  climate, 
for  those  patients  compelled  to  consider  expense. 
The  good  results  from  this  procedure  are  most 
strongly  urged.  When  there  is  any  weakness  of  the 
pulmonary  vessels,  or  when  it  is  inadvisable  to  in- 
crease the  blood  pressure  in  the  brain,  or  kidneys,  or 
other  abdominal  viscera,  the  method  is  contra-indi- 
cated. 

Expiration  into  Condensed  Air: — Should  be  com- 
bined w^ith  inspiration  of  condensed  air  for  the  relief 
of  congestion  and  stimulation  of  absorption  as  in 
consolidation  persistent  after  pneumonia,  and  in 
chronic  pleurisy  with  effusion.  This  is  highly  recom- 
mended for  tuberculosis,  but  is  inferior  to  inspira- 
tion of  condensed  air  w^ith  expiration  into  rarefied 
air.  This  method  is  also  recommended  in  cases 
where  the  expiration  is  imperfectly  performed,  as  a 
means  of  strengthening  the  respiratory  muscles.  It 
has  been  found  of  service  in  convalescence  from  pul- 
monary tuberculosis  and  as  a  prophylactic  against 
the  same. 

Expiration  into  Rarefied  Air: — Combined  with  in- 
spirations of  condensed  air,  may  be  employed  when 
it  is  desired  to  increase  the  activity  of  the  circulation 


640  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

of  the  amount  of  air  in  the  lungs,  or  to  get  rid  of  ac- 
cumulations in  the  alveoli,  bronchi  or  quiescent  cav- 
ities. 

Inspiration  of  Rarified  Air: — Employed  to 
strengthen  the  muscles  of  inspiration  by  increased 
exercise.  It  is  indicated  in  cases  of  contracted 
thorax,  as  a  preventive  against  pulmonary'  dis- 
ease.    (F.) 

In  spite  of  the  high  commendations,  the  use  of  the 
pneumatic  cabinet  has  rather  declined  than  in- 
creased. This  may  be  owing  to  the  impossibility  of 
its  practical  application,  for,  in  order  to  be  efficient, 
the  apparatus  should  be  used  two  or  three  times  a 
day,  with  intervals  of  rest;  therefore,  unless  the 
patient  has  one  at  home  or  is  in  a  hospital  provided 
with  one,  the  treatment  is  of  no  avail. 

Fresh  Air  Cure: — The  plan  of  this  treatment  is  to 
place  the  patient  in  as  perfect  a  condition  as  possible 
as  far  as  air  and  hygiene  are  concerned.  It  has  been 
pursued  at  the  Hospital  of  Ormesson,  situated  in  the 
remote  part  of  the  plateau  of  Champigny,  at  an 
elevation  above  the  sea  of  about  308  feet  and  over- 
looking the  valley  of  the  river  Mame.  The  buildings 
serving  as  dormitories  consist  of  two  immense 
w^ooden  pavilions,  the  capacity  of  which  is  not  less 
than  101,710  cubic  feet  of  air,  constantly  renewed 
by  perforated  windows.  No  special  medication  is 
employed  excepting  cod  liver  oil  in  very  cold 
weather.  Unless  there  are  contra-indications  each 
patient  is  bathed  twice  a  week,  thoroughly  soaked, 
then  vigorously  rubbed  in  order  to  obtain  a  com- 
plete reaction  of  the  skin.  Very  good  results  are 
claimed.     (T.,  97.) 

Open  Air  Treatment: — This  should  form  part  of 


TUBERCULOSIS.  641 

the  treatment  in  all  cases  except  those  in  the  last 
stages  of  the  disease.  Patients  should  live  in  the 
open  air,  and  a  good  part  of  their  time  should  be 
spent  in  the  recumbent  posture.  The  clothing  should 
be  light,  but  sufficiently  warm,  preferably  of  wool, 
both  in  underclothing  and  dress.  The  head  should 
be  protected. 

Wind  should  be  avoided,  but  otherwise  the  w^eather 
need  not  be  regarded.  As  soon  as  accustomed  to 
outdoor  life,  and  able  to  take  short  excusions,  the 
patient  should  do  so  even  if  a  shower  is  to  be  en- 
countered. He  should  be  careful  to  protect  himself 
with  waterproof  overcoat  and  shoes,  and  guard 
against  getting  cold  or  wet.  Foggy  atmosphere  is 
not  an  insuperable  objection,  but  is  undesirable.  The 
ventilation  of  the  sleeping  room  is  of  great  import- 
ance. The  best  method  of  airing  the  room  in  winter 
is  by  means  of  a  bright  fire  and  an  open  window.  If 
there  is  no  fire  the  w^indow  should  be  open  night  and 
day.     (P.,  8,  99.) 

Climate: — The  importance  of  open  air  life  cannot 
be  too  greatly  emphasized.  When  patients  can  spend 
all  day  out  of  doors,  and  w^hen  indoors  live  in  a  pure 
atmosphere  they  will  do  well.  There  is  no  climate 
where  patients  can  be  sent  indiscriminately  ;  a  suit- 
able locality  must  be  selected  for  each  case.  Gener- 
ally speaking,  a  dry,  equable  temperature  should  be 
chosen;  yet  dryness  is  not  by  any  means  alw^ays  a 
requisite,  as  evidenced  by  the  beneficial  effects  of  Tor- 
quay and  Falmouth,  in  England,  places  noted  for 
humidity.  Low  altitudes  are  sedative  and  soothing, 
high  are  stimulating  and  invigorating.  The  extreme 
cold  of  an  Adirondack  v^^inter  and  the  mild  tempera- 
ture of  Florida  and  the  West  Indies  must  both  be 
42 


642  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

considered.  Sea  voyages  may  prove  beneficial  to 
those  who  are  fond  of  the  sea  and  are  naturally 
good  sailors. 

In  regard  to  altitude  the  following  are  the  conclu- 
sions of  Dr.  F.I.  Knight :  * 

High  altitude  is  most  likely  to  prove  of  benefit 
when  the  age  is  under  fifty,  temperament  phlegmatic 
rather  than  nervous,  with  weak  heart,  feeble  pulse, 
and  inabilit3^  to  resist  cold.  Those  showing  irrita- 
bility from  disease  are  not  to  be  included  in  the  lat- 
ter, as  they  are  generally  benefited. 

As  regards  disease  those  with  : 

1.  Early  apical  affections,  with  little  constitu- 
tional disturbance,  are  most  benefited. 

2.  Cases  of  more  advanced  disease,  with  evidences 
of  consolidation,  without  excavation  or  any  serious 
disturbance  do  well.  When  the  apices  are  both  much 
involved,  the  pulse  generally  over  100,  and  the  tem- 
perature above  100°,  it  is  better  to  begin  with  a 
low  altitude. 

3.  Haemorrhagic  cases,  early  cases  with  haemopty- 
sis and  without  fever,  or  much  evidence  of  disease, 
are  benefited. 

4.  Patients  with  advanced  disease;  those  w^ith 
cavities  or  severe  hectic  symptoms,  should  not  go  to 
high  altitudes.  A  small  quiescent  cavity  is  not  a 
contra-indication ;  hectic  symptoms  on  the  other 
hand  are. 

5.  Patients  in  an  acute  condition  should  not  be 
sent. 

6.  Patients  with  fibroid  phthisis  are  not  suitable 
subjects. 

^Transactions of  the  American  and  Climatological  Assn.,  i888. 


TUBERCULOSIS.  643 

7.  Convalescents  from  pneumonia  and  pleurisy 
usually  do  well. 

8.  Advanced  cases  of  laryngeal  tuberculosis  may 
not  do  worse  than  elsewhere,  if  good  local  treatment 
and  freedom  from  dust  can  be  obtained. 

9.  When  other  diseases  complicate,  much  care  is 
necessary.  Cardiac  dilatation  and  hypertrophy, 
nervous  palpitations,  and  diabetes  are  contra-indica- 
tions.  A  cardiac  murmur,  the  result  of  an  old  endo- 
carditis, with  no  sign  of  enlargement  or  deranged 
circulation,  should  not  deter,  neither  is  syphilis  a 
contra-indication . 

The  following  classification  of  localities,  according 
to  Dr.  G.  A.  Evans,  w^ill  be  found  useful : 

1.  Cool  and  moderately  mild;  general  elevation 
2,000  feet;  western  slope  of  the  Appalachian  chain, 
Adirondacks,  Catskill,  Allegheny,  and  Cumberland 
Montains. 

2.  Moderately  warm  and  moderately  moist; 
elevation  2250;  western  North  Carolina  (Asheville), 
western  South  Carolina,  Aiken,  Georgia,  Marietta, 
and  Thorn  as  ville. 

3.  Warm  and  moist;  Florida  (equable),  southern 
California,  coast  region  (equable). 

4.  Warm  and  moderately  dry ;  elevation  2000  feet; 
southern  Texas,  southern  California,  inland. 

5.  Cool  and  moderatelj^  dry;  elevation  1000  feet; 
Minnesota,  Nebraska,  Dakota. 

6.  Cool  and  dry;  elevation  from  4000  to  7000 
feet;  Montana,  Wyoming,  Colorado,  northern  New- 
Mexico,  western  Kansas. 

7.  Warm  and  dry;  elevation  3000  to  5000  feet; 
southern  New  Mexico,  southern  Arizona.     (Ev.) 

Sanitaria: — These  institutions  have  demonstrated 


644  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

their  utility  beyond  all  question.  Although  they 
have  as  yet  only  been  established  at  moderate  eleva- 
tions, their  statistics  show  twice  as  many  cures  as 
the  open  air  treatment  in  the  same  altitude.  The 
rigid  hygienic  rules  and  the  constant  intelligent 
supervision  of  the  daily  life  of  the  patient  have 
doubtless  much  to  do  with  bringing  about  these  re- 
sults. The  comparative  nearness  and  cheapness  of 
these  institutions  place  them  within  the  reach  of  per- 
sons of  moderate  means,  to  whom  the  expenses  of  a 
long  journey  and  hotel  bills  are  matters  of  consid- 
eration. 


TYPHOID   FEVER. 

The  use  of  cold  baths  is  now  recognized  as  having 
not  only  reduced  the  mortality,  but  also  the  fre- 
quency of  complications,  excepting  haemorrhage. 
Some  practitioners  employ  them  regularly  at  6  a. 
m.,  1  to  3  p.  m.,  and  7  p.  m.,  but  the  majority  prefer 
to  administer  them  with  more  or  less  frequency  ac- 
cording to  the  range  of  temperature. 

Brand  Treatment: — A  bath  is  prepared  at  a  tem- 
perature of  65°  to  80°,  filling  the  tub  two-thirds 
full;  the  patient,  if  sweating,  should  be  dried,  and 
the  bladder  emptied.  To  avoid  annoyance  it  is 
better  to  screen  the  bath  during  preparation.  When 
all  is  ready  the  patient  is  covered  with  a  sheet  and 
gently  placed  in  the  tub.  While  in  the  bath  vigorous 
rubbing  is  applied,  except  on  the  abdomen;  this  is 
essential  to  prevent  cyanosis  and  collapse.  An  ice 
compress  may  be  applied  on  the  head  or  effusion  of 
ice  water  poured  on  it.    This  measure  is  regarded  as 


TYPHOID   FEVER.  645 

important  in  cases  with  severe  nervous  symptoms, 
and  should  be  continued  for  fifteen  minutes.  The 
bed  should  have  been  previously  provided  with  a 
rubber  sheet  and  blanket,  the  patient  should  now  be 
rubbed  dry  and  wrapped  in  a  blanket,  hot  water 
bags  applied  to  the  extremities  and  the  rubber  sheet 
and  under  blanket  withdrawn.     (Gn.) 

As  soon  as  the  patient  ceases  to  shiver  after  the 
bath  the  temperature  should  be  taken.  After  an  in- 
terval of  three  hours  it  may  be  again  taken ;  if  it  is 
then  102°  or  above,  the  bath  is  repeated.  If  102°  or 
below,  but  above  101°,  it  is  taken  again  in  an  hour ; 
if  below  101°  and  above  100°  in  ten  hours.  When 
the  temperature  reaches  102.2°  a  bath  may  be  given, 
provided  three  hours  have  elapsed  since  the  last. 
<Ty.) 

Von  Ziemssen's  modification  of  the  Brand  bath  is 
v^hat  is  known  as  the  graduated  bath.  The  v^'-ater 
is  prepared  at  a  temperature  of  85°  to  90°  and  grad- 
ually lowered  hj  adding  water  at  a  temperature  of 
40°.  The  minimum  temperature  is  72°,  and  the  dur- 
ation of  the  bath  half  an  hour.  Rubbing  is  also  nec- 
essary. While  adding  the  cold  water  care  must  be 
taken  not  to  allow  it  to  come  in  contact  w^ith  the 
hody.     (Gn.) 

A  folding  rubber  tub  has  recently  been  introduced, 
w^hich  can  be  slipped  under  the  patient  without  re- 
moving him  from  the  bed.  The  sides  of  the  tub  are 
so  arranged  as  to  permit  of  being  erected  around  the 
patient;  the  tub  thus  being  on  the  bed  itself. 
Through  a  large  tubing,  about  four  inches  in  diame- 
ter, the  water  both  enters  and  runs  off,  thus  permit- 
ting quick  filling  and  emptying. 

Cold  Sponging: — For  the  reduction  of  temperature 


646  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

this  may  frequently  be  preferred  to  the  cold  bath,  as 
the  liability  to  shock  is  lessened,  and  the  exhausting 
effects  of  the  patient's  removal  from  bed  obviated. 
Commence  with  water  at  a  temperature  of  90°  and 
gradually  lowered  to  70°  or  less  according  to  the 
bodily  temperature,  which  must  be  carefully 
w^atched.  An  important  feature  is  the  exposure  of 
the  surface  to  the  atmosphere  during  the  sponging, 
as  the  evaporation  rather  than  the  temperature  of 
the  water  cools  the  body.  It  is  advisable  to  allow  a 
film  of  water  to  remain  on  the  surface.  The  spong- 
ing should  continue  for  about  tw^enty  minutes.  Alco- 
hol is  sometimes  used  instead  of  water,  especially  in 
hot  weather,  when  it  is  preferable.  Sponging  with 
ice  water  is  also  used.     (M.  H.) 

Ice  Cradle: — This  consists  of  an  ordinary  iron  cra- 
dle sufficiently  long  to  entirely  cover  the  patient,^ 
who  lies  underneath  covered  w^ith  some  light  muslin. 
Attached  to  the  cross-bars  are  small  zinc  baskets 
filled  with  ice.  The  baskets  are  covered  with  lint  to 
prevent  any  condensation  of  moisture  falling  on  the 
patient.  The  cradle  is  covered  with  a  counterpane 
except  at  the  two  ends,  w^hich  are  left  open  to  allow 
a  constant  interchange  of  air.  Hot  bottles  are  placed 
at  the  patient's  feet.  Before  the  cradle  is  used  the 
patient  should  be  sponged  v^ith  tepid  water.  Fen- 
wick,  w^ho  has  offered  this  method  as  a  substitute 
for  the  bath,  claims  it  is  as  effective  in  reducing  the 
temperature.  (Gn.)  The  advantages  are  the  avoid- 
ance of  shock  of  the  cold  bath  and  the  removal  of 
the  patient  from  bed. 

Cold  Air  Treatment: — Subjecting  the  patient  to 
cold  air  from  a  freezing  machine  has  been  suggested 
for  hospital  use  by  J.  Murray  Gibbes,  in  the  Aust. 


TYPHOID  FEVER.  647 

Med.  Gaz.,  April  24,  1897.  It  would  seem  that  the 
ice  cradle  of  Fenwick  would  accomplish  the  same  end 
in  a  much  more  simple  way. 

Wet  Pack: — Not  as  effective  as  the  bath,  still  is 
very  useful  in  reducing  temperature.  It  has  the  merit 
of  convenience,  and  may  be  used  several  times  a  day, 
the  patient  remaining  in  it  from  five  minutes  to  an 
hour,  according  to  the  temperature.     (B.) 

Enemata: — When  there  is  constipation  enemata 
should  be  administered  unless,  the  bowels  are  relieved 
by  calomel. 

Lavage  of  the  Colon: — For  the  condition  of  catar- 
rhal inflammation  and  of  infiltration  and  ulceration 
often  present  in  the  colon  and  caecum  this  measure 
will  serve  a  three-fold  purpose ;  it  cleanses  the  bowel 
of  excreta  and  other  toxic  matter,  allays  the  inflam- 
matory process  and  tends  to  prevent  tympanites. 
For  washing  the  colon  use  a  soft  rubber  colon  tube 
and  inject  from  1  to  3  pints  of  warm  sterilized  water, 
either  plain  or  holding  boric  acid,  borax  or  common 
salt  in  solution.  The  fluid  should  be  allowed  to  fill 
the  colon,  distending  it  moderately,  then  to  flow  out. 
In  cases  of  very  high  temperature  colon  enemata  of 
ice  water  have  been  used  with  good  results. 

Cleansing  the  Mouth: — This  minor  but  important 
detail  of  treatment  should  not  be  neglected.  A  sw^ab 
and  spray  may  be  used.  The  cleansing  solution 
should  consist  of  some  mild,  non-poisonous  anti- 
septic, such  as  some  of  the  well-known  so-called 
pharmaceutical  preparations  containing  Eucalyptus, 
Boric  Acid  and  Thymol,  or  Dobell  Solution,  or  a 
mixture  of  dilute  Phosphoric  Acid  with  Lemon 
Juice  glycerine  and  water,  which  forms  agreeable 
and  useful  washes.    ' 


9^.    Ung.  Ichthyoli, 

Lanolini, 

aa  3ij. 

Ung.  Belladonnae, 

q.  s.  ad  5j- 

M. 

648  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Rectal  Tube: — When  tympanites  is  very  distress- 
ing this  may  be  cautiously  used ;    sometimes  large 
quantities  of  gas  are  thus  discharged. 
Turpentine  Stupes: — For  meteorism.     (An.) 
Ichthyol: — For  thrombosis  of  the  femoral  vein  ele- 
vation of  the  part  and  the  following  ointment : 


(An.) 

Treatment  of  Haemorrhage. 

Absolute  quiet  in  the  recumbent  posture  is  impera- 
tive. The  foot  of  the  bed  should  be  elevated,  Ice  ap- 
plied to  the  abdomen,  and  the  patient  should  suck 
small  pieces  of  ice.  All  food  should  also  be  iced. 
Milk  must  be  discontinued  or  given  with  carbonate 
of  soda,  or  in  the  form  of  alum  whey  (that  is  finely 
powdered  alum  is  mixed  with  milk  and  the  curds 
separated  from  the  whey). 

Morphine: — Subcutaneous  doses  of  |  to  ^  grain 
may  be  administered  with  advantage.     (Ty.) 

Ergotine: — Formerly  much  used,  but  less  so  now. 
It  is  best  administered  hypodermically  in  doses  of  1 
to  3  grains. 

A  formula  for  subcutaneous  injection  is  as  follows, 
the  chloral  is  added  to  prevent  decomposition : 

9?..   Ergotini,  3ij' 

Chloral.  Hydratis,  5®®. 

Aq.  Destill.,  5j. 

M. 

Sig.     Inject  lo  to  20  minims  in  the  gluteal  muscles. 

Ice  Water  Injections : — These  have  been  used  with 
success. 


TYPHOID  FEVER.  649 

Normal  Saline  Infusion:  —  Notwithstanding  the 
fact  that  the  value  of  saline  solution  in  typhoid  fever 
is  well  attested,  this  measure  does  not  appear  to 
have  received  the  attention  to  which  it  is  entitled. 
The  number  of  cases  in  Avhich  it  has  been  employed 
are  comparatively  small,  yet  by  reference  to  Neale's 
Appendix  to  the  Medical  Digest,  1891—95,  a  consid- 
erable number  w^ill  be  found  recorded. 

Intravenous  Normal  Saline  Injections: — The  util- 
ity of  this  measure,  together  with  the  quantity  of 
fluid  injected,  is  illustrated  by  the  following  case  re- 
ported by  Dr.  J.  Ramsey  (Inter-Colonial  Med.  Jour., 
of  Australia,  Nov.  20,  1898): 

"  A  man,  aged  46  years,  had  severe  typhoid  fever;  the  temperature 
was  104.2°  F.,  and  the  pulse  was  100.  He  passed  8  ounces  of  blood 
and  on  the  following  day  10  ounces,  and  a  few  more  ounces  with 
the  stool.  The  temperature  fell  to  97.6°,  the  pulse  was  from  70  to 
80,  the  respiration  was  sighing,  and  the  skin  was  clammy.  Brandy, 
strychnine,  and  digitalis  were  given  without  effect.  The  pulse  be- 
came weaker  and  unconsciousness  and  lividity  of  the  hands  and 
ears  supervened.  He  was  practically  moribund.  2  pints  of  normal 
saline  solution  at  100°  was  injected  into  the  median  cephalic  vein. 
Towards  the  end  of  the  injection  the  pulse  improved  in  volume  and 
the  general  appearance  became  better.  But  the  effect  was  only 
temporary.  The  patient  was  livid  and  lay  with  half  closed  eyes, 
hiccoughing,  vomiting,  and  passing  urine  involuntarily.  Four 
hours  after  the  first  injection  1%  pints  of  the  solution  were  in- 
jected. Improvement  again  followed,  which  was  more  lasting. 
After  this  the  fever  ran  the  ordinary  course,  a  relapse  of  ten  days' 
duration  occurred,  and  he  slowly  convalesced." 

Rectal  Saline  Injections: — The  advantages  of  this 
method  of  administering  the  normal  saline  solution 
over  the  intravenous  are  the  ease  and  expedition 
w^ith  which  it  can  be  given.  The  value  of  rectal 
saline  injections  is  illustrated  by  the  following  case 
(W.  M.  Gabriel,  M.  D.,  Lancet,  Jan.  21,  1899): 


650  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

' '  A  man ,  aged  3 1 ,  had  repeated  attacks  of  severe  intestinal  haemor- 
rhage in  typhoid  fever.  The  last  left  him  apparently  /«  extremis^ 
with  all  the  signs  of  immediately  impending  death  from  collapse. 
Other  means  having  been  exhausted,  there  was  injected  into  the 
rectum  a  pint  of  hot  saline  solution,  which  had  to  be  retained  by 
artificial  means  owing  to  the  contractility  of  the  sphincter  ani  be- 
ing suspended.  After  several  minutes  had  elapsed  a  faint  indica- 
tion of  the  radial  pulse  became  perceptible  and  the  sphincter  shortly 
afterwards  resumed  its  function.  All  other  ordinary  means  were 
then  adopted  to  aid  reaction,  but  six  hours  later  it  was  deemed  ad- 
viable  to  repeat  the  rectal  injection.  The  result  was  distinctly 
favorable.     Recovery  ensued." 

Operation  for  Intestinal  Perforation. 

The  question  of  the  advisabiHty  of  operating  for 
intestinal  perforation  in  typhoid  fever  has  been  an- 
swered in  the  affirmative.  All  cases  are  deemed  suit- 
able except  those  in  which  recovery  is  manifestly 
hopeless.  In  a  series  of  one  hundred  and  fifty  cases 
collected  by  Dr.  W.  W.  Keen,  of  Philadelphia,  the 
percentage  of  recoveries  was  22.7  per  cent.,  while  in 
those  not  operated  upon  the  percentage  of  recoveries 
is  said  to  be  5  per  cent.  The  same  observer  presents 
the  following  conclusions :  The  surgeon  should  be 
called  in  consultation  as  soon  as  any  symptoms  in- 
dicative of  perforation  are  observed.  After  perfora- 
tion has  occurred  the  operation  should  be  performed 
as  soon  as  primary  shock  has  subsided;  the  most 
favorable  period  for  operating  being  the  second 
twelve  hours  after  perforation.  In  doubtful  cases  a 
small  exploratory  incision  should  be  made.  The 
operation  should  be  performed  quickly  and  under 
local  anaesthesia ;  general  anaesthesia  is  condemned. 

The  technique  of  operating,  according  to  Dr.  Keen, 
is  as  follows :    The  point  of  incision  is  best  made  in 


TYPHOID   FEVER.  651 

the  right  Hnea  semikmaris  or  through  the  rectus 
muscle.  If  the  peritonitis  is  so  extensive  as  not  to 
permit  of  a  thorough  cleansing  of  the  abdominal 
cavity  a  second  incision  may  be  made  in  the  left 
iliac  fossa.  The  perforation  should  be  looked  for 
first  in  the  ileum  then  in  the  caecum  and  appendix. 
When  found  it  should  be  sutured  with  the  Halstead 
mattress  suture,  without  paring  the  edges.  If  a  sec- 
ond row  of  sutures  is  necessary  this  may  be  continu- 
ous. Care  should  be  observed  not  to  invert  the 
bow^el  sufficiently  to  impair  its  lumen  to  any  ex- 
tent. When  the  perforation  is  very  extensive,  or  sev- 
eral are  adjacent,  resection  of  the  bowel  will  be  nec- 
essary. The  abdominal  cavity  should  be  very  care- 
fully cleansed;  this  is  a  matter  of  the  greatest  im- 
portance. Drainage  is  generally  necessary.  Speed 
in  operating  is  a  very  important  factor. 

Disinfection. 

The  following  are  the  conclusions  of  W.  Oilman 
Thompson,  M.  D.,  read  at  the  N.  Y.  State  Med.  Soc, 
on  Jan.  28,  1897: 

1.  The  best  disinfectants  for  typhoid  urine  and 
stools  are:  (1)  A  1-500  acidulated  solution  of  corro- 
sive sublimate ;  (2)  a  1—10  crude  carbolic  acid  solu- 
tion; (3)  chlorinated  lime. 

2.  Owing  to  the  possibility  of  injury  to  plumbing, 
the  carbolic  acid  solution  is  preferable  wherever 
plumbing  is  concerned.  The  lime  is  best  for  country 
use  in  privies  and  trenches. 

3.  The  disinfectant  should  be  thoroughly  mixed 
with  the  stool,  and  left  in  contact  with  it  for  fully 
two  hours.     Enouffh    of  the    disinfectant    must  be 


652  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

added  to  completely  cover  the  stool  with  the  solu- 
tion. 

4.  The  bed-pan  should  be  kept  ready  filled  at  all 
times  with  at  least  a  pint  of  the  disinfectant,  into 
which  the  stool  is  at  once  discharged,  and  should  be 
filled  with  scalding  water  and  one  of  the  disinfecting 
solutions. 

5.  Rectal  thermometers,  syringes,  tubes,  and  all 
utensils  coming  in  contact  with  the  faecal  matter 
must  be  disinfected  with  the  corrosive  sublimate  or 
carbolic  acid  solution. 

6.  After  each  stool  the  patient's  perinasum  and  ad- 
jacent parts  should  be  washed  and  sponged  with  a 
1—2000  corrosive  sublimate  solution. 

7.  Nurses  and  attendants  should  be  cautioned  to 
wash  their  own  hands  thoroughly,  and  immerse 
them  in  a  1-1000  corrosive  sublimate  solution  after 
handling  the  bed-pan,  thermometer,  sj^ringe  or  pa- 
tient, or  giving  sponge  or  tub  baths. 

8.  All  linen  or  bed  clothing  used  by  the  patient 
should  be  soaked  in  a  1—20  carbolic  acid  solution, 
and  subsequentl3^  boiled  for  fully  two  hours. 

9.  Disinfection  of  the  stools  should  be  begun  as 
soon  as  the  diagnosis  of  enteric  fever  is  established, 
and  should  be  continued  for  ten  daj'S  after  the  tem- 
perature has  remained  normal. 

10.  In  localities  where  a  proper  drainage  system  is 
lacking,  the  st  ools  should  either  be  mixed  wnth  saw^ 
dust  and  cremated,  or  buried  in  a  trench  four  feet 
deep  after  being  covered  with  chloride  of  lime. 


TYPHUS  FEVER.  653 


TYPHUS  FEVER. 

The  general  management  is  similar  to  typhoid 
fever,  with  the  important  exception  of  the  element  of 
the  contagion.  On  account  of  the  extremely  con- 
tagious character  of  the  disease  the  strictest  isola- 
tion is  imperative.  It  is  best  treated  by  placing  the 
patient  in  a  tent,  as  thereby  the  safety  of  the  attend- 
ants is  enhanced  and  recovery  favored.  When  this 
is  not  possible  all  carpets,  hangings  and  unnecessary 
furniture  should  be  removed  from  the  patient's  room. 
There  is  no  regular  special  method  of  treatment. 

Cold  Baths: — These  are  advocated  on  the  same 
plan  as  for  typhoid  fever  with  similar  indications. 
They  are  advised  -when  the  patient's  temperature  re- 
mains at  104°.  The  folding  rubber  tub,  so  devised 
that  the  tub  can  be  slipped  under  the  patient  and 
filled  v^ithout  removing  him  from  the  bed,  may  be 
used.  In  addition  to  the  cold  baths  as  mentioned, 
Ziemssen  advises,  when  the  patient's  temperature 
reaches  104°,  a  bath  which  is  gradually  reduced 
from  9°  to  36°  below  the  patient's  temperature. 
Bouchard's  method  consists  in  commencing  w^ith  a 
bath  2°  below  the  patient's  tempetature  and  gradu- 
ally reducing  it  to  54°.    (J.  R.  K.)    (T.  C,  Vol.  XV.) 

In  regard  to  the  use  of  cold  baths  in  this  disease 
Drs.  B.  F.  Westbrook  and  S.  M.  Brickner  (Foster's 
Practical  Therapeutics,  Vol.  I),  express  the  following 
opinion :  "  The  cold  bath  has  been  used  with  alleged 
success  in  the  treatment  of  typhus  fever.  Opportuni- 
ties for  the  observation  of  this  disease  are  rare  in 
this  country,  but  the  rationale  of  the  bath  would 
seem  to  indicate  its  proper  use  in  typhus  fever." 


654  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Tepid  Baths: — The  prolonged  tepid  bath  with  ice 
to  the  head  when  delirium  is  intense  is  advocated  in 
young  and  vigorous  children.  Reiss  emploj^s  a  tepid 
bath  at  a  temperature  of  87°,  continued  for  twenty- 
four  hours. 

Sponging: — This  may  take  the  place  of  baths,  us- 
ing cold  water  or  iced  alcohol  as  conditions  indicate, 

Wet  Pack: — When  the  temperature  is  high  the  skin 
hot  and  drj^  this  may  prove  of  service  in  suitable 
cases. 

Asafcetida  Enemata: — In  coma  this  measure  has 
given  some  wonderful  results. 

Antiseptic  Enemata: — Sterilized  water  at  a  tem- 
perature of  59°  to  68°,  holding  in  solution  4  per  cent, 
of  borax  as  an  enema,  or  one  of  potass,  permang.,  1- 
10,000,  not  only  w^ill  tend  to  disinfect  the  bowel,  but 
w^ill  reduce  the  temperature.  Oxygenated  w^ater,  10 
per  cent.,  at  a  temperature  of  53°  to  59°,  v^nll  prove 
of  value.     (T.  C,  Vol.  XV.) 

Simple  Enemata — When  there  is  constipation  the 
bowels  should  be  relieved  by  enemata  of  soap  and 
water.    (Am.) 

Injection  of  Stimulants  : — Stimulation  being  more 
or  less  indicated  throughout  the  whole  course  of  the 
disease  on  account  of  the  great  danger  of  death  from 
asthenia.  Whiskey,  Ammonia,  Strychnia,  and  Digi- 
talis may  be  administered  subcutaneously  when  an 
immediate  action  is  desired,  or  when  it  is  not  advis- 
able to  give  these  remedies  by  the  mouth. 

Catheterization : — Paralysis  of  the  bladder  is  a  fre- 
quent sj^mptom.  Hence,  if  there  is  a  constant  drib- 
bling of  urine  it  must  not  be  supposed  it  comes  from 
incontinence,  for  the  probabilities  are  that  it  is  the 
overflow  of  a  distended  bladder ;  the  catheter  should, 


ULCERS.  655 

therefore,  be  passed  every  five  to  six  hours.  (T.  C, 
Vol.  XV.) 

Artificial  Serum. — According  to  M.Sapelier  (Revue 
Internationale  de  Medicine  et  de  Chirurgie,  August 
10,  1894),  artificial  serum  may  be  injected  in  all 
stages  of  the  disease.  High  fever  is  the  most  import- 
ant indication.  The  temperature  of  the  fluid  should 
be  at  least  86°  F.  The  injection  of  artificial  serum  is 
claimed  to  be  superior  to  cold  baths  in  lowering  the 
temperature,  the  effects  lasting  for  twelve  to  four- 
teen hours.  The  urine  becomes  free  and  clear,  and  is 
passed  in  large  quantities.  The  albumen  disappears 
and  the  toxines  are  eliminated. 

The  most  rigid  disinfection  is  demanded  in  typhus 
fever.  Everything  which  has  been  in  contact  with 
the  patient,  or  in  his  room,  or  in  any  way  exposed 
to  the  contagion  should  be  burned,  baked,  boiled,  or 
subjected  to  the  action  of  antiseptic  solutions  or 
vapors  according  to  the  nature  of  the  article. 


ULCERS. 

Cleanliness,  antisepsis,  avoidance  of  irritation,  and 
complete  phj'^siological  rest  are  the  essentials  of 
treatment.  First  cleanse  w^ith  warm  water  and 
some  good  soap,  Castile  or  medicated,  scrub  with 
brush  the  surrounding  skin  and  bathe  thoroughly 
with  an  antiseptic  lotion,  the  strength  of  which  will 
depend  upon  the  nature  of  the  lesion;  generally  it 
should  be  mild  to  avoid  irritation,  using  such  lotions 
as  saturated  solutions  of  boric  acid,  or  sublimate  1- 
6000,  though  some  writers  advocate  much  stronger 
applications.    After  this  the  selected  dressing  may  be 


656  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

applied.  When  the  ulcer  is  situated  on  the  lower  ex- 
tremity, rest  may  be  attained  by  means  of  elevation 
of  the  limb  or  placing  the  patient  in  bed.  Not  a  few 
ulcers  which  have  resisted  all  other  efforts  for  induc- 
ing resolution  will  at  once  begin  to  heal  v^'-hen  the  re- 
cumbent posture  is  maintained.  The  element  of  rest 
in  bed  applies  to  the  treatment  of  ulcers  of  all  varie- 
ties w^hen  situated  on  the  lower  extremity. 

There  are  a  vast  number  of  remedial  agents  w^hich 
have  been  recommended  for  this  lesion,  many  of 
which,  in  view  of  modern  antisepsis  and  asepsis,  are 
now  obsolete. 

The  different  varieties  of  ulcers  with  some  of  the 
w^ell-attested  methods  of  treatment  are  as  follows : 

HEALTHY  ULCERS. 

Avoid  irritation  and  permit  the  surface  to  cica- 
trize.   If  large,  apply  the  follow^ing : 

1^.    Hj'drarg.  Chloridi  Mitis, 

Ung.  Zinc.  Oxidi  Carbolatis,  aa  3J. 

M. 
Sig.     Over  this  place  protective  or  gutta  percha. 

Simple  antiseptic  dressings  are,  as  a  rule,  better 
than  ointments. 

For  stimulation  when  healing  is  slow,  Nitrate  of 
Silver  or  Chloral  Hydrate,  of  either  gr.  x— §j.     (A.) 

IRRITABLE  ULCERS. 

Dusting  powders  of  a  soothing,  drjang  character, 
such  as  Airol,  Acetanilid,  Iodoform,  lodol,  etc. 

Cocaine  with  Belladonna  Ointment,  5  grains  to 
the  ounce;  or  Fid.  Ext.  Grindelia  diluted  with  water 
or  glycerine.  (Sm.)  The  Curette  may  be  used  for 
removal  of  sensitive  granulations.     (A.) 


ULCERS.  657 

INFLAMED  ULCERS. 

When  there  is  extensive  inflammation,  continuous 
warm  antiseptic  baths  will  convert  the  sore  into  a 
simple  one.     (Den.) 

Calendula: — Very  useful;  a  solution  of  1  part  to  5 
to  6  of  a  iy2  per  cent,  solution  of  carbolic  acid. 
Soothing  in  action.  Used  also  for  ulcers  of  other  va- 
rieties.    (M.  H.) 

FUNGOID   ULCERS. 

Employ  agents  which  w^ill  constringe  vessels  and 
a,ppl3^  pressure  with  cotton  bandage.  The  following 
solutions  are  useful : 

Copper  Sulphate,  gr.  j— x— §j. 

Zinc  Sulphate,  gr.  j— x— sj. 

Silver  Nitrate,  gr.  j— x-sj. 

Nitrate  of  Silver  Crayon.     (Den.) 

CBDEMATOUS  ULCERS. 

After  the  prolonged  use  of  wet  dressings  or  poul- 
tices ulcers  are  likely  to  become  oedematous.  The 
margin  may  appear  fairly  healthy,  but  the  granula- 
tions elsewhere  will  have  become  sv^ollen,  pale,  semi- 
transparent  and  friable,  exuding  watery  pus.  Treat- 
ment must  be  stimulating,  including  applications  of 
the  following  nature : 

Resin  Ointment,  Balsam  Peru,  Astringents  and 
Mechanical  Support.     (Den.) 

INDOLENT,  CALLOUS  OR  CHRONIC  ULCERS. 

For  cleansing  and   disinfecting,  wash    ulcer  with 
soap  and  water.  Saturate  the  surrounding  skin  with 
43 


658  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

turpentine  and  scrub  with  4  per  cent,  carbolic  acid 
solutions  or  sublimate  1-500,  using  a  nail  brush ; 
cleanse  the  ulcer  itself  with  zinc  chloride  1-40.  The 
ulcer  may  now  be  painted  wdth  pure  carbolic  acid. 
Having  removed  the  septic  material,  cease  appljang 
irritants  and  dress  with  boric  acid  (saturated  solu- 
tion), first  applying  Lister's  oiled  silk  to  protect  sore 
from  irritation  of  lint ;  change  daily.     (Tre.) 

If  a  cicatricial  margin  prevents  the  flow  of  arterial 
blood,  radiating  incisions  may  be  made;  if  venous 
return  is  impeded,  use  the  curette,  freely  disinfect 
'with  the  solution  of  zinc  chloride  or  hydrogen  perox- 
ide, and  subsequently  appl^'  antiseptic  dressings. 
(Den.) 

Naphthalin: — Recent  observers  claim  that  this 
remedy  possesses  very  great  therapeutic  pow^ers  in 
promoting  the  healing  of  extensive  sores  and  ulcers 
of  the  skin.  The  special  benefits  are  particularly  ob- 
vious in  cases  of  chronic  ulcer  of  the  leg.  The  irregu- 
larly-shaped ulcer,  with  its  profuse  discharge  and 
ragged  edges,  is  rapidly  converted  into  a  healthy 
ulcer,  the  base  of  which  becomes  covered  with 
healthy  granulations.  Inflammation  and  oedema  of 
the  surrounding  skin  also  subside.  The  beneficial 
effects  are  usually  marked  after  the  first  week  of 
treatment,  being  manifested  by  the  diminution  of  the 
discharge  and  the  change  in  aspect  of  the  ulcer.  The 
following  is  the  method  of  application:  A  piece  of 
cotton-wool  corresponding  to  the  size  of  the  ulcer  is 
first  dipped  for  a  few  minutes  in  an  antiseptic  lotion ; 
then  naphthalin  is  spread  on  it  and  put  on  the  sore 
parts;  over  this  a  piece  of  gutta-percha  tissue  is 
placed  and  the  whole  secured  by  a  bandage,  care 
being  taken  that  the  parts,  previous  to  the  applica- 
tion,  have  been  bathed  and  carefully  cleaned.    At 


ULCERS.  659 

first  the  bandage  is  changed  after  eight  or  ten  days ; 
later  it  may  be  left  for  a  longer  period.  The  advan- 
tages of  this  treatment  are  summed  up  as  follows : 
(1)  It  greatly  expedites  the  healing  process;  (2)  it 
does  not  irritate  the  parts  with  w^hich  it  comes  in 
contact;  (3)  it  is  easily  handled ;  (4)  the  expense  is 
trifling;  (5)  a  point  of  very  great  importance — it 
prevents  putrefaction  of  the  discharges.  (P.  M.  J.,  5, 
27,  99.) 

Sulphate  of  Copper: — Useful  in  ulcers  occurring  in 
broken  down  constitutions ;  first  poultice  for  several 
days;  after  the  surface  is  fairly  clean  apply  lint 
soaked  in  a  solution  of  gr.  v-x-gj,  then  bandage 
from  toes  to  knee.     (Al.) 

Tr.  Aloes: — After  cleansing  and  antisepsis  of  the 
ulcerated  surface,  dry  carefully  with  absorbent  cot- 
ton ;  then  if  the  sore  is  superficial,  paint  it  once  w^ith 
the  tincture  of  aloes ;  if  deep,  paint  it  tw^ice ;  next  a 
piece  of  impermeable  linen  is  applied  and  the  leg  is 
w^rapped  entirely  in  aseptic  gauze  and  cotton.  (T., 
98.) 

Unna's  Dressing: — This  is  to  be  used  w^hen  the  skin 
is  diseased,  apart  from  the  ulcer.  The  method  is  as 
follows :  After  prolonged  cleansing  of  the  ulcer  with 
soap  and  hot  water,  brush  it  with  rough  antiseptic 
gauze,  and  disinfect  it  with  some  antiseptic  wash. 
Next  the  entire  region  affected  with  varicose  eczema 
is  coated  with  a  thick  layer  of  Lassar's  paste  (see 
Appendix  II),  and  the  ulcer  itself  is  dusted  with  iodo- 
form, aristol  or  dermatol,  and  covered  w^ith  cotton. 
The  entire  leg  is  then  painted  w^ith  Unna's  dressing, 
melted  and  applied  w^ith  a  brush.  The  parts  that  are 
covered  with  Lassar's  paste  must  also  be  coated 
with  Unna's  dressing,  which  is  as  follows : 


660  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

^.    Zinc.  Oxidi, 

Gelatini,  aa  gr.  ccc. 

Glycerin! , 

Aquae,  aa   ^iiss. 

M. 
The  leg  is  bandaged  with  tarlatan,  which  has  been  soaked  in  hot 
water.  The  bandage  is  drawn  tight  in  order  to  obtain  moderate 
compression;  over  this  a  dry  bandage  is  placed.  In  from  two  to 
six  days  the  discharges  will  pass  through  the  bandage,  which  must 
then  be  changed.  Under  this  treatment  secretions  dry  up,  and  the 
bandages  are  renewed  only  once  a  week.     (T.,  98. ) 

Nitrate  of  Silver: — A  valuable  stimulant  in  leg 
ulcers,  and  those  following  bums.  When  cicatriza- 
tion has  begun,  care  must  be  taken  not  to  touch  the 
pink  line  which  surrounds  the  granulations  and  skin. 
(Al.) 

Airol: — Useful  in  ulcers  of  leg,  particularly  when 
complicated  with  eczema.  As  a  dusting  powder  it 
is  superior  to  iodoform. 

Europhen  : — Same  indications  as  for  airol. 

Euphorbium: — 1  part  to  20  as  an  ointment.     (F.) 

Hydrastine  Hydrochlorate: — Gr.  v  — xxx  — 5j  as  a 
cerate,  especially  on  mucous  surfaces. 

Dermatol: — Checks  serous  exudation  and  stimu- 
lates granulations ;  useful  as  a  desicant. 

Iodoform: — Often  irritating  to  varicose  ulcers,  and 
those  attended  with  eczema ;  more  useful  for  venereal 
than  non-specific  sores.     (Al.) 

Sodium  Chloride:  — 10  parts  to  1  of  powdered 
menthol.  Mix  thoroughly  and  use  as  dusting  pow- 
der after  cleansing  surface.     (T.,  98.) 

Sozoiodol: — Similar  in  action  to  iodoform,  only 
more  effective.     ( Al. ) 

Tr.  Ferr.  Chloridi: — An  old  remed3'  for  indolent 
and  varicose  sores,  painted  over  daily,  has  been 
highly  praised .     ( Rd . ) 


ULCERS.  661 

Naphthol: — 5  to  10  per  cent,  ointment.     (Sm.) 
Creosote:  —  The  following  combination  when  the 
discharge  is  excessive : 

1^.    Creosoti,  M.iv. 

Tr.  Galbani,  gij. 

Aquae,  ^ij. 

M.  (Sn.) 

Bovininc: — As  a  digestive  to  remove  sloughs  has 
been  used,  it  is  claimed,  with  some  success.     (Tre.) 

Monochloratic  Acid  and  Trichloratic  Acid: — Give 
satisfactory  results  w^hen  caustic  action  is  required. 
Healing  takes  place  with  little  or  no  cicatrization. 
(F.) 

Ung.  Basilicon,  Ung.  Bal.  Peru,  Ung.  Hydrarg. 
Nit.,  old  standard  stimulating  applications,  still 
much  used.     (N.) 

VARICOSE  ULCERS. 

Aristol: — 10  per  cent,  ointment  is  excellent.     (Sn.) 

Hamamelis: — The  cerate,  ointment  or  compress. 
(Rd.) 

Creolin: — Gauze  dipped  in  a  2  per  cent,  solution 
and  covered  with  wool  compress  or  gauze  kept  con- 
stantly wet.  Sloughs  and  odor  rapidly  disappear. 
(Sj.) 

Pyoktanin: — After  cleansing  with  a  solution  of  so- 
dium bicarbonate  apply  a  solution,  5  grains  to 
water,  2  ounces.  Apply  to  entire  base  and  margin 
after  drying;  cover  with  absorbent  cotton,  then 
with  Martin's  elastic  bandage.     (Sj.) 

Europhen  and  Boric  Acid: — 1  part  of  former  to  1 
to  3  of  the  latter.     (Sj.) 

Strapping: — Use  adhesive  plaster;  commence  at  the 
base  of  the  toes  and  strap  all  the  way  up  to  about 


662         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

three  inches  above  the  ulcer.  This  method  has  been 
successful  in  the  author's  hands.  The  entire  foot,  ex- 
cept the  heel,  should  be  enveloped. 

Traumatol: — As  a  dusting  powder  or  ointment  em- 
ployed same  as  an  iodoform  has  been  used  with  suc- 
cess.    (F.) 

Curettage: — The  following  method  is  recom- 
mended. First  wash  the  ulcer  thoroughlj'  w^ith  soap 
and  w^ater,  giving  a  good  scrubbing  w^ith  a  stiff  nail 
brush;  then  curette  thoroughl3^  and  free  the  edges 
from  their  attachment,  check  haemorrhage  with  com- 
presses soaked  in  a  2  per  cent,  solution  of  carbolic 
acid ;  now  apph^  strips  of  diachjdon  plaster,  and 
cover  with  absorbent  cotton.  If  granulations  be- 
come exuberant,  apply  caustics.     (T.,  97.) 

Tr.  of  Aloes: — Applied  as  alreadj^  described  for  in- 
dolent ulcers  is  useful  for  ulcers  of  this  tj'-pe. 

The  integrity  of  the  circulation  should  be  restored 
by  mechanical  means.  For  this  purpose  a  properly 
fitted  Elastic  Stocking  is  invaluable.  Martin's  Elas- 
tic Bandage  is  also  excellent,  but  requires  care  in 
application.  When  neither  the  bandage  nor  stock- 
ing is  available,  a  muslin  or  flannel  roller  should  be 
used.     (W.) 

FOUL,  SLOUGHING  AND  GANGRENOUS  ULCERS. 

For  cleansing  and  irrigating,  the  following  solu- 
tions : 

Mercuric  Bichlorid.,  1-2000  or  3000. 

Potass.  Permang.,  15  to  60  gr.-Oj. 

Carbolic  Acid,  1-40. 

Hydrogen  Peroxide,  pure  or  diluted.    • 

Styron,  1-12. 

Trichlorphenol,  1  or  2-100. 


ULCERS.  -  663 

Creosote  Water,  Mj-5j  or  stronger. 

Bromium,  1-1000. 

Labarraque's  Solution. 

Sodium  Hyposulphite,  1  to  5  or  10  parts  of  water, 
tept  in  contact  with  lint  will  correct  fetor  and  tend 
to  establish  health3^  reaction.     (Al.) 

Charcoal: — A  number  of  small  flat  bags  containing 
charcoal  placed  on  foul  surfaces  will  destroy  the 
fetor.     (F.) 

Peat: — In  the  form  of  fine  powder,  dusted  on,  has  a 
good  effect  and  tends  to  promote  healthy^  granula- 
tion.   It  should  be  frequently  repeated.     (F.) 

Bismuth  Subiodide :  — May  be  used  for  packing 
ulcer  when  it  is  impossible  to  apply  dressing;  after 
which  it  may  be  sealed  up.     (Al). 

Creosote: — Undiluted,  may  be  brushed  on  foul  and 
ind  olent  ulcers .     ( Al . ) 

Xeroform: — In  cases  where  cauterization  has  been 
applied  it  is  most  excellent  dusted  over  surface.     (F.) 

TUBERCULOUS  ULCERS. 

Local  measures  are  of  the  utmost  importance,  the 
aim  of  treatment  being  the  complete  removal  of  the 
disease. 

Antiphthisine: — Applied  to  ulcers  of  this  variety 
causes  them  to  become  clean  and  to  show  a  tendency 
to  heal. 

Menthol  and  Iodoform: — Equal  parts;  better  than 
iodoform  alone.     (Al.) 

Calcium  Phosphate: — 1-100  in  solution,  with  a 
little  free  phosphoric  acid,  has  succeeded,  it  is  said 
Tvhen  other  remedies  have  failed.     (Al.) 

Mercury: — Calomel  ointment  and  black  wash  are 


664  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

recommended  for  lesions  of  the  tuberculous  syphilitic 
variety.     (R.) 

Curette  and  Cautery:— These  constitute  effective 
measures.  They  should  be  followed  by  iodoform 
dressings.     (Tre.) 

Excision: — This  may  be  preferred,  especially  when 
followed  by  skin  grafting.     (Tre.) 

SCROFULOUS  ULCERS. 

Treatment  in  the  main  similar  to  tuberculous 
ulcers,  with  exception  of  antiphthisine. 

Phosphoric  Acid: — 50  grains  to  1  ounce  of  distilled 
water ;  lint  dipped  in  the  solution  and  renewed  three 
or  four  times  a  day  has  been  employed.     (Al.) 

Acid  Nitrate  of  Mercury: — More  or  less  dilute  solu- 
tion.    (Al.) 

PHAGEDENIC  ULCERS.    See  Phagedena. 


Unna's  method  for  an  iodoform  dressing  and  for 
stiffening  an  ordinary  bandage  in  order  to  give  sup-^ 
port  and  compression  is  as  follows : 

1.  Wash  the  skin  with  soap  and  v^ater. 

2.  Apply  an  antiseptic  lotion. 

3.  Powder  w^ith  iodoform. 

4.  Take  a  double-headed  bandage  and  apply,  com- 
mencing at  the  middle  of  the  sore.  The  bandage 
should  be  porous  and  over  it  is  rubbed  a  mixture  of 
gelatine  and  glycerine,  10  parts  of  gelatine,  40  of 
glycerine,  and  40  of  water,  with  some  oxide  of  zinc. 
This  is  melted  and  rubbed  into  the  bandage ;  before 
it  is  set  another  bandage  is  dipped  in  hot  water  and 
applied.    The  bandages  are  renewed  according  to  the 


ULCERS.  665 

amount  of  discharge,  usually  at  first  every  day.  They 
can  be  easily  removed  by  the  patient  placing  the  leg 
in  a  pail  of  hot  water.  A  bandage  so  applied  gives 
good  support.     (Tre.) 

Ichthyol: — 25  per  cent,  aqueous  solution  is  recom- 
mended in  ulcers  of  all  varieties.     (Tre.) 

Alum: — In  solution  in  relaxed  and  abundantly 
secreting  sores.     (R.) 

Thiol: — Antiseptic  and  protective,  1  drachm  with 
vaseline  1  drachm,  and  lanolini  1  ounce,  or  a  powder, 
viz.: 

^.    ThioliSic,  3J. 

Zinc.  Oxidi,  §ij. 

Amyli,  |j. 

Talci,  |ii. 
M. 

Tanniform: — 10  per  cent,  ointment  or  powder  with 
starch  same  strength. 

Tumenol: — 5  to  10  per  cent,  ointment  in  slight 
superficial  ulceration. 

Potassium  Sozoiodolate: — An  odorless  and  non- 
poisonous  substitute  for  iodoform.  Use  pure  or 
diluted  with  from  three  to  ten  times  its  weight  of 
starch  or  talc.     (F.) 

Terebene: — Used  as  a  substitute  for  carbolic  acid 
in  antiseptic  dressings. 

Alum:  —  Useful  desicant  for  suppressing  fungoid 
granulations  and  to  stimulate  indolent  and  sanious 
ulcerations.  It  acts  as  an  escharotic  on  tissues  in 
process  of  growth.     (N.) 

Hot  and  Cold  Effusions: — During  the  process  of 
healing,  pouring  hot  w^ater  on  the  limb  followed  by 
cold  is  beneficial  for  restoring  and  equalizing  the  cir- 
culation in  ulcers  of  the  extremities. 


666  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Massage:  —  Rubbing  gently  toward  the  body  is 
often  of  service  during  the  process  of  resolution,  espe- 
cially when  there  is  much  oedema. 

SYPHILITIC  ULCERS.    See  Syphilis. 


UREMIC  POISONING. 

The  Vapor  or  Hot  Air  Bath,  or  the  Hot  Pack, 
shoul  dbe  employed  at  once ;  the  latter  is  very  effic- 
ient and  less  enervating.     (Ty.) 

Pilocarpine: — Subcutaneously  administered  in  con- 
junction w^ith  the  hot  pack,  in  doses  of  Vs  grain  of 
the  muriate  or  less,  is  one  of  the  most  important 
remedies ;  if  diaphoresis  does  not  set  in,  repeat  in 
half  an  hour.     (Ty.) 

The  administration  of  this  drug  is  very  generally 
recommended  in  uraemic  poisoning,  yet  it  has  re- 
cently been  observed  that  it  is  not  free  from  danger. 
In  patients  in  whom  there  is  reason  to  suppose  there 
is  degeneration  of  the  circulatory  s^^stem,  especially 
those  advanced  in  life,  w^hether  such  changes  can  be 
detected  or  not,  the  use  of  pilocarpine  is  regarded  by 
some  observers  as  contra-indicated. 

Jaborandi: — An  infusion  of  the  leaves  3j,  to  water 
Jiv,  when  cool  strained,  and  injected  into  the  rectum, 
acts  almost  as  well  as  pilocarpine. 

Atropine  : — gL  grain  hypodermically ;  indicated  if 
there  is  pulmonary  oedema. 

Chloral  Hydrate: — 1  drachm  by  the  rectum  may  be 
used  with  good  effect  if  convulsions  persist;  15  to  30 
grains  may  be  given  to  a  child. 

Morphia:  —  Hypodermically,    in    large    doses;    V2 


UREMIC   POISONING.  667 

grain  was  used  by  Prof.  Loomis  in  urasmic  convul- 
sions complicating  acute  nephritis.  Caution,  how- 
ever, should  be  observed  in  its  use.     (Ty.) 

Digitalis: — A  poultice  of  leaves  to  the  abdomen 
and  lumbar  region  may  be  used  (B.),  or  ^4  grain  of 
the  extract,  hj'-podermically.     (R.) 

Dry  or  V/et  Cups: — Applied  over  lumbar  region 
may  prove  of  service. 

Normal  Saline  Solution: — This  is  an  effective  and 
powerful  agent  in  the  last  stages  of  ureemia.  It  may 
be  administered  in  all  cases,  either  by  the  intraven- 
ous, subcutaneous,  intramuscular  or  rectal  method. 
Intravenous  or  subcutaneous  administration  is  gen- 
erally preferred.  See  Normal  Saline  Solution,  Ap- 
pendix II. 

Intramuscular  adminstration  was  first  recom- 
mended by  M.  Dumarest,  who  sums  up  his  experi- 
ence as  follows:  " These  injections  exert  the  best  in- 
fluence on  the  toxic  symptoms  due  to  changes  in  the 
kidney  and  even  on  simple  albuminuria.  Pulmonary 
oedema  and  anasarca  are  not  contra-indications. 
The  salt  water  probably  acts  as  a  tonic  and  anti- 
toxic." (T.,  98.)  The  same  observations  apply  to 
the  solution  when  administered  by  other  methods. 

High  Enemata: — Moderately  cool,  have  been  ad- 
vised to  promote  diuresis ;  also  at  blood  heat  w^ith  1 
per  cent,  salt  added.     (M.  H.) 

Inhalations  of  Amyl  Nitrate,  Oxygen  and  Nitrogen 
combined  are  used  for  oppression  in  breathing ;  hy- 
podermics of  Strychnine  or  Ether,  especially  the 
former,  are  measures  to  be  considered  when  collapse 
is  imminent. 


668  DIGEST   OF   EXTERNAL  THERAPEUTICS. 


URETHRITIS. 

ACUTE  URETHRITIS— GONORRHCEA. 

Abortive  treatment  is  generally  condemned  by 
many  recent  -writers  as  productive  of  more  harm 
than  good. 

Injections : — As  a  rule  injections  should  not  be  ad- 
vised during  the  advancing  stage,  as  long  as  internal 
remedies  appear  to  be  acting  satisfactorily;  weak 
solutions  of  bichloride  of  mercurj',  however,  as  men- 
tioned in  the  succeeding  paragraphs,  may  be  em- 
ployed with  good  effect.  In  the  use  of  injections  care 
should  be  observed  not  to  exert  force  or  to  overdis- 
tend  the  urethra,  nor  to  send  the  fluid  beyond  the 
first  few  inches  of  the  pendulous  portion;  they 
should  not,  moreover,  be  of  sufficient  strength  to 
cause  pain  or  an  uncomfortable  sensation  of  fulness 
when  used  for  the  first  time.  Injections  may  be  ad- 
ministered three  or  four  times  a  day  and  always 
after  urinating.     (CI.) 

The  selection  of  the  syringe  is  a  matter  of  import- 
ance; it  should  be  conical-pointed  and  known  as 
"excelsior  P,"  according  to  Dr.  Lydston. 

Hydrarg.  Bichlorid.: — During  the  advancing  stage, 
injections,  if  made  at  all,  should  be  very  mild. 

A  weak  solution  of  1-20,000  or  40,000  may  be 
used  as  a  douche  with  Kiefer's  two-ways  tube  at- 
tached to  a  fountain  syringe ;  1  to  2  quarts  may  be 
thus  administered.  (CI.)  These  weak  solutions  form 
about  the  best  injections  for  this  period  of  the  dis- 
ease. 


URETHRITIS.  669 

Solutions  of  1-20,000  or  30,000  may  also  be  used 
by  injection  with  good  effect  in  the  secondary  stage 
of  severe  acute  urethritis.  Strong  solutions  are  of 
doubtful  efficacy  and  may  cause  intense  pain  and  in- 
crease inflammation.    (CI.) 

If  severe  smarting  on  urination  folloAvs  the  use  of 
the  bichloride,  in  a  day  or  two,  the  solution  must  be 
weakened  or  discontinued. 

In  place  of  the  sublimate  during  the  increasing 
stage,  the  following  anodyne  injection  may  be  given : 


9;.    Atrop.  Sulphatis, 

gr.  ij. 

Bismuth.  Subnitratis, 

3iv. 

Mucil.  Acaciae, 

Aq.  Destill., 

aa  gij. 

M. 

Sig.     Shake  well  and  inject 

three  times  a  day. 

5fc.    Morph.  Sulphatis, 

gr.  viij. 

Cocainae, 

gr.  iv. 

Mucil.  Acacise, 

Sj; 

Aq.  Destill., 

q.  s.  ad  gij. 

M. 

(B.  H.) 

If  mild  and  sedative  astringents  in  combination 
"with  anodynes  are  desired,  the  following  will  be 
found  useful  formulae : 

9;.    Plumbi  Acetatis,  gr.  iv. 

Vini  Opii,  3ij- 

Aq.  Rosse,  q.  s.  ad  giv. 

M. 

Sig.     Inject  three  times  a  day. 

Or, 

^.    Sod.  Boratis,  gr.  xx. 

Morph.  Sulphatis,  gr.  vj. 

Aq.  Rosae,  giv. 

M. 
Sig.     Inject  three  times  a  day.  (B.  H.) 


670  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

For  a  purely  sedative  effect : 

5fe.    Acid.  Borici,  jij. 

Aq.  Ext.  Opii,  gr.  xv. 

Liq.  Plutnbi  Subacetat.  Dil.,  ^vj. 

M.  "  (CI.) 

Hydrogen  Peroxide,  solution  of  1  to  4  and  Potass. 
Permang.,  1-4000,  are  useful  injections  for  the  first 
stage.     (F.) 

Pyrozone: — 1  per  cent,  solution  can  also  be  used  to 
advantage.     (CI.) 

Ichthyol : — 1  to  2  per  cent,  solution  as  an  irriga- 
tion is  claimed  to  be  indicated  in  preference  to  any 
other  remedy.  It  may  be  used  in  the  beginning  of 
the  attack,  two  irrigations  daily  for  five  or  six  days, 
but  if  it  is  not  well  borne  and  there  is  no  modifica- 
tion of  the  discharge,  suspend  until  the  subacute 
stage  is  reached.  In  the  period  of  decline  1  to  2  per 
cent,  solutions  will  generally  lead  to  a  rapid  cure. 
The  remedy  thus  employed  is  painless.     (T.,  97.) 

Zinc: — In  the  stationary  stage  of  the  disease  as- 
tringent injections  in  stronger  solutions  are  indi- 
cated. The  most  popular  and  one  of  the  best  is  zinc 
sulphate,  though  the  sulpho-carbolate  or  the  iodide 
are  preferred  by  some. 

The  following  are  recommended : 

^.    zinc.  Sulphatis  vel  Acetatis,  gr.  xii. 

Morph.  Sulphatis,  gr.  x. 

Glycerini,  ^j. 

Aq.  Rosse,  ^iij. 
M. 

Or, 

ffc.    Zinc.  lodidi,  gr.  viij. 

Acid.  Carbolici,  gr.  iv. 

Aq.  Destill.,  ^iv. 
M. 


URETHRITIS.                                         67 

9=. 

Pliunbi  Acetatis,                                                gr.  xx. 

Tr.  Opii,                                                            3ij. 

Aq.  Rosse,                                            q.  s.  ad  ^iv. 

M. 

(B.  H.) 

^. 

Zinc.  Sulpho-Carbolatis,                                  gr.  ij-v. 

Aq.  Rosae,                                                            §j. 

M. 

(CI.) 

"Injection  Brou,"  well  known  among  the  laity,  ac- 
cording to  Bumstead,  is  as  follows : 

9;.    Zinc.  Sulpliatis,  gr.  xv. 

Plumbi  Acetatis,  gr.  xxx. 

Fid.  Ext.  Kramerise, 

Tr.  Opii,  aa  ^iij. 

Aquae,  ad  ^vj. 
M. 

Ricord  recommended  the  following : 

9;.    Zinc.  Sulphatis, 

Acid.  Tannici,  aa  gr.  xv. 

Aq.  Rosse,  ,^vj. 

M. 
Sig.     Inject  half  an  ounce  two  or  three  times  daily. 

Hydrastis: — One  of  the  most  eifective  of  the  vege- 
table astringents,  the  muriate  of  the  alkaloid  being 
much  used. 

The  following  formulae  are  efficacious : 


9. 

Aq.  Ext.  Hydrastis, 

3J-iJ- 

Zinc.  Sulphatis, 

gr.  iv-viij. 

Aquae, 

lij. 

M. 

(CI.) 

9. 

Hydrastin.  Muriatis, 

gr.  X. 

Fid.  Ext.  Hamamelidis, 

3U- 

Glycerini, 

53- 

M. 

Aq.  Destill., 

q.  s.  ad 

(B.  H.) 

In  the  stage  of  deline  the  strength  of  the  injections 


672  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

may  be  increased  sometimes  to  double  the  propor- 
tions given.  This  must  be  done  carefully,  and  in  no 
instance  should  any  be  administered  which  produces 
considerable  pain.  A  slight  smarting  only  is  to  be 
expected.  If  any  injection  is  found  to  cause  increased 
pain  or  burning  on  micturition  it  should  be  weak- 
ened or  discontinued.     (Cltn.) 

Gallobromal: — 1  to  2  per  cent,  solution,  said  to  be 
especially  efficient  as  an  injection  for  the  relief  of 
chordee.     (F.) 

Pyoktanin: — Solutions  of  1—1000  are  effective  in 
killing  gonococci.  (B.)  Solutions  of  1-1000  or  2000 
retained  one  minute,  in  sixty-eight  cases,  were  pain- 
less, in  3  were  intensely  painful.     (Sj.) 

Sulphate  of  Thallin: — Solution  of  20  grains  with 
rose  water,  1  ounce,  often  useful.     (B.  H.) 

Nitrate  of  Silver: — Frequently  of  great  service. 
Treatment  with  this  remedy  by  injections  of  solution 
of  1—4000  (gr.  j— gix),  never  stronger  than  1—2000, 
was  recommended  by  Friedheim  and  Neilson  to  be 
instituted  early.  The  immediate  effect  is  to  increase 
the  discharge,  which  in  the  course  of  four  days  be- 
comes thinner,  w^hiter  and  less  abundant.  After  a 
fair  trial  of  the  above  solutions,  if  the  discharge  con- 
tinues, the  strength  of  the  injection  may  be  increased 
to  gr.  j— §iv,  or  it  maj'^  be  changed  to  sulphate  of 
zinc  or  some  other  astringent.  According  to  Neisser, 
nitrate  of  silver  stands  at  the  head  of  the  list  of  rem- 
edies for  gonorrhoea,  and  bichloride  of  mercury  sec- 
ond. The  remedy  is  also  recommends  for  the  second- 
ary stage. 

When  in  the  stage  of  decline,  examination  of  the 
urethra  with  the  Otis  urethrometer  or  bulbous 
bougie  gives  evidence  of  small  areas  of  granulation 


URETHRITIS.  673 

or  urethral  inflammation,  1  or  2  drops  of  a  solution 
usualh'  of  the  strength  of  4  to  10  grains  per  ounce 
maj'  be  applied  everj'  third  day  with  good  results, 
using  for  the  purpose  the  Keyes-Ultzmann  syringe. 
The  best  results  are  said  to  be  those  obtained  by 
commencing  \vith  the  weakest  solution  and  increas- 
ing the  strength  as  indicated,  using  an  instrument 
devised  103^  R.  W.  Taylor.  About  30  drops  of  a  1- 
2000  solution  are  taken  up  in  an  ounce  glass  sj^ringe 
with  the  nozzle  drawn  to  a  sharp  point;  a  No.  8 
French  gum  catheter  is  cut  to  the  length  of  8^^ 
inches  and  introduced  to  the  point  desired  with  the 
patient  standing.  The  proper  amount  is  now  in- 
jected, the  catheter  w^ithdrawn  and  a  piece  of  ab- 
sorbent cotton  applied  to  the  meatus,  w^hich  may  be 
retained  b}^  an  elastic  band  or  the  foreskin  to  protect 
the  linen. 

Solutions  of  nitrate  of  silver,  grs.  v— xl— ^j,  applied 
by  means  of  a  pledget  of  cotton  on  an  aluminum 
probe  through  the  endoscope,  are  indicated  when  the 
granulations  are  large  and  numerous,  but  should  not 
be  used  more  frequently  than  once  in  four  to  eight 
days.     (CI.) 

Protargol: — This  chemical  combination  of  silver 
and  albumen  has  been  used  with  gratifying  results. 
It  is  soluble  in  both  hot  and  cold  water,  and  may  be 
administered  hj  urethral  injection  in  solution  of  l^to 
2  per  cent.  The  weaker  solution  should  be  used  first, 
and  the  strength  gradually  increased  to  the  stronger. 
About  2  drachms  may  be  injected  and  retained  for 
two  minutes. 

These  solutions  can  be  administered  as  soon  as  the 
gonococci  are  found  in  the  discharge;  they  do  not 
injure  the  mucous  membrane,  but  act  rapidly  in  de- 
44 


674  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

stroying  the  gonococci.  After  the  disappearance  of 
the  latter,  astringent  injections,  such  as  zinc  sulphate, 
may  be  substituted.  The  remedj^  apparenth^  acts  as 
a  prophlactic  after  exposure  to  gonorrhoea. 

Carleton  gives  the  folloAving  directions  for  the  use 
of  protargol : 

Commence  with  a  urethral  injection  of  a  ^  per 
cent,  solution,  gradualh'  increase  the  strength  to  a  2 
per  cent  solution  by  the  seventh  day,  continue  until 
all  gonococci  have  disappeared  from  the  discharge, 
when  a  supplementary  astringent  injection  will  be 
indicated,  which  must  be  gradually  increased  in  fre- 
quency as  the  protargol  douches  are  diminished.  If 
the  protargol  solutions  are  completely  discontinued 
and  too  early  replaced  by  astringents,  reinfection 
often  occurs.  Astringents  must  not  be  used  too  early 
in  gonorrhoeal  urethritis  as  they  may  imprison  the 
gonococci  in  the  deeper  layers  of  epithelia  and  retard 
cure.  3  drachms  of  the  selected  solution  should  be  in- 
jected into  the  urethra  by  means  of  No.  83,  Butler 
Rubber  Company's,  or  similar  three-drachm  syringe, 
after  each  micturition,  the  frequency  of  the  calls  to 
urinate  determining  the  number  of  urethral  douches 
per  day.  Protargol  solutions  should  always  be  re- 
tained in  the  urethra  three  to  five  minutes  during  the 
day,  and  ten  minutes  at  bedtime ;  the  astringent  in- 
jections from  one  to  two  minutes. 

The  usual  duration  of  treatment  bj'  this  method  is 
from  three  to  four  weeks,  though  if  the  urethi-a  is 
free  from  congenital  or  pathological  conditions  and 
the  case  is  seen  early  a  cure  may  sometimes  be  ac- 
complished in  from  three  to  four  days.  (N.  A.  J.  H., 
4,  99.) 

Argonin: — A  combination  of  silver  and  casein;  is 


URETHRITIS.  675 

very  similar  to  protargol ;  it  is  used  in  8  per  cent,  so- 
lutions. Its  action  is  also  satisfactory,  though  great 
care  should  be  observed  in  its  preparation,  for  un- 
pleasant results  will  follow  an  improperly  prepared 
article.     (M.  T.,  11,  98.) 

It  occurs  as  a  Avhite  pow^der  which  must  be  dis- 
solved in  cold  water  by  carefully  warming  over  a 
water  bath.  In  a  concentrated  solution  it  is  more 
or  less  opalescent  and  must  be  kept  in  a  dark  vessel. 
Its  maximum  strength  of  concentration  is  1  part  to 
10  of  water.  15  parts  of  the  powder  contain  as 
much  silver  as  1  part  of  silver  nitrate.  Its  action  on 
the  urethra  is  not  very  irritating  or  escharotic  even 
in  concentrated  solutions,  and  causes  but  little  pain 
and  no  inflammatory  reaction.  It  possesses  germi- 
cidal but  no  astringent  properties.  The  following 
are  the  solutions  usually  employed  :  For  the  anterior 
urethra,  15-3000,  quickly  increasing  to  16-750;  for 
the  posterior  urethra,  15-500  to  15-200.  The  solu- 
tions are  used  both  by  irrigation  and  injection,  the 
latter  being  made  bj-^  the  patient  three  or  four  times 
a  day,  holding  the  fluid  in  the  urethra  for  five  to  ten 
minutes.  The  Guy  on  syringe  is  used  for  the  posterior 
urethra.     (A.  D.  S.,  95.)     (Cltn.) 

Arg :  nin  L : — This  new  preparation  of  argonin,  ac- 
cording to  Jellink  (Wien.  Med.  Woch.,  No.  5,  1899), 
possesses  the  advantage  of  being  more  readily  solu- 
able  in  cold  water  and  of  being  able  to  be  kept  in 
solution  several  months  without  decomposing.  1 
per  cent,  solutions  are  used  in  anterior  and  posterior 
urethritis.  Cases  of  anterior  urethritis  should  re- 
ceive injections  three  times  daily,  retaining  the  same 
for  five  minutes.  Posterior  urethritis  may  receive  in- 
stillations with  the  Ultzmann  syringe.    After  disap- 


676  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

pearance  of  the  gonococci  astringent  injections  of 
sulphate  of  zinc  are  employed.  The  results  of  this 
treatment  are  said  to  demonstrate  the  superiority^of 
the  new  preparation. 

Argentamine: — For  anterior  urethral  injection  so- 
lutions of  1-5000  to  4000,  and  of  1-4000  to  2000  are 
recommended.  For  deep  urethral  injections  15  to  30 
minims  of  a  solution  of  1—1000  to  500.  This  remedy, 
it  is  claimed,  is  suited  to  any  stage;  it  penetrates 
more  deeply  than  nitrate  of  silver,  which  produces 
w^ith  albumen  and  sodium  chloride  insoluble  com- 
pounds. The  secretion  is  increased  at  first,  then  de- 
creases rapidly.  Treatment  should  continue  for 
about  two  weeks.     (Sj.) 

Krosing  treated  fifty-five  cases  with  this  remedy  in 
strengths  of  1-4000  to  1-2000.  The  injections  were 
made  four  times  daily,  after  careful  cleansing  of  the 
prepuce  and  glans  with  the  same  solution,  and  were 
retained  each  time  for  from  five  to  ten  minutes.  The 
posterior  cases  w^ere  treated  with  1-1000  solutions 
by  means  of  Guyon's  syringe.  The  gonococci  were 
destroyed  in  ten  days  on  an  average.  Posterior 
urethritis  occurred  four  times,  and  epididymitis 
tw^ice;  other  complications  were  not  observed.  In 
nine  cases  there  v^as  a  relapse  after  from  one  to  six 
weeks.  Irritative  effects  were  apparent  only  in 
slightly  increased  secretion  during  the  first  days  of 
treatment;  they  w^ere  not  marked  enough  to  cause 
the  patients  to  complain.     (D.  Z.,  Vol.  IV,  No.  5.) 

Mercurol: — Mercurol  is  an  organic  compound  of 
of  mercury  with  nuclein,  containing  about  10  per 
cent,  of  mercury.  It  exists  as  a  light,  brownish- 
white  powder,  and  is  soluble  in  water,  especially' 
-when  the  latter  is  warm,  but  is  insoluble  in  alcohol. 


URETHRITIS.  677 

It  is  employed  in  solutions  of  from  0.25  per  cent,  to 
2  per  cent,  the  diluent  being  normal  salt  solution.  In 
most  cases  treated  a  1  per  cent,  solution  was  used, 
which  is  equivalent  to  a  1-1000  solution  of  mercury. 
The  patients  are  instructed  to  inject  every  two 
hours,  holding  the  injection  in  two  minutes,  and  to 
report  every  day  for  microscopic  examination  of  the 
discharges. 

The  best  results  were  observed  in  cases  of  simple 
anterior  urethritis.  In  those  in  which  the  posterior 
urethra  was  involved  the  results  were  not  so  good> 
but  this  may  be  due  to  the  remedy  being  used  too 
w^eak.  It  is  claimed  that  mercurol  is  unirritating 
and  has  cured  gonorrhoea  is  less  than  four  weeks. 
(T.  G.,  11,  15,  99.) 

Retrojection: — This  is  more  effective  than  simple 
injection,  but  has  the  disadvantage  of  requiring  as- 
sistance for  the  application  of  its  technique.  The 
patient  should  sit  on  the  edge  of  a  chair  over  a 
basin ;  then  an  ordinary  woven  catheter,  well  lubri- 
cated, is  inserted  to  the  depth  of  about  five  inches; 
to  the  catheter  a  rubber  tubing,  four  or  five  feet  long, 
is  attached,  which  is  connected  with  a  fountain 
syringe  or  irrigator  of  1  to  2  quarts  capacity ;  the 
irrigator  is  then  elevated  two  or  three  feet  until  the 
solution  runs  in  and  forces  its  way  out  at  the  meatus 
alongside  the  catheter;  the  urethra  is  thus  washed 
out  with  the  entire  contents  of  the  irrigator.  The 
same  solutions  may  be  used  as  those  employed  for 
injections,  but,  as  a  rule,  they  should  be  somewhat 
Aveaker.     (F.) 

This  method  is  regarded  by  some  writers  as  not 
only  of  difficult  application,  but  of  questionable  util- 


678  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

ity,  except  in  cases  which  have  a  tendency  to  become 
chronic. 

Irrigation: — This  procedure,  which  has  already 
been  frequently  mentioned,  is  especially  indicated 
when  the  posterior  urethra  is  involved.  The  most 
effective  method  of  application  is  that  of  Ultzmann, 
which  consists  of  the  introduction  just  be^^ond  the 
compressor  urethrae  muscle  of  a  short  silver  catheter 
with  four  longitudinal  slits  instead  of  the  usual  eye ; 
a  hard  rubber  syringe  of  3  to  4  ounces  capacity  is 
filled  with  the  selected  solution  and  attached  by 
means  of  a  soft  rubber  tubing,  then  the  fluid  is  gently 
injected  into  the  membranous  urethra,  w^hen,  over- 
coming the  internal  sphincter,  it  will  flow  into  the 
bladder;  this  is  repeated  until  the  bladder  is  filled. 
When  the  patient  desires,  he  is  allowed  to  urinate 
through  the  urethra,  the  catheter  being  removed. 
Irrigations  should  be  administered  in  the  recumbent 
posture  and  the  solutions  should  be  well  warmed. 
The  same  solutions  vaay  be  used  as  for  retrojection. 
A  favorite  method  of  Ultzmann  was  to  begin  with  a 
solution  of  sulphate  of  zinc,  alum,  and  carbolic  acid, 
each  1  part  to  2000  of  water ;  on  the  next  day  this 
was  increased  to  1-1500,  on  the  third  1-1000,  on 
the  fouth  1-500.  If  this  was  well  tolerated  the  solu- 
tion w^as  changed  to  one  of  potassium  permangan- 
ate, 1-2000,  w^hich  was  increased  in  strength  in  the 
same  way  up  to  1-1000,  when  a  solution  of  nitrate 
of  silver,  1-2000,  was  emplo3''ed,  which  in  turn  was 
gradually  increased  up  to  1-1000;  in  this  way  the 
urethra  becomes  accustomed  to  the  solutions  with- 
out inconvenience.  When  it  is  not  desirable  to  pass 
a  catheter,  the  bladder  may  be  filled  by  hydrostatic 
pressure  alone.     (F.) 


URETHRITIS.  679 

Instillation: — This  method  is  employed  for  the  ap- 
plication of  a  small  quantity  of  a  strong  solution  to 
the  posterior  portion  of  the  urethra  without  the  an- 
terior being  affected.  To  accomplish  this,  use  the 
drop  syringe,  which  consists  of  a  short  silver  cathe- 
ter with  very  thick  walls  and  a  capillary  lumen,  to 
its  proximal  end  a  hypodermic  syringe  is  attached ; 
the  desired  amount  of  the  solution  is  drawn  up  into 
the  syringe,  the  catheter  introduced  until  the  end  has 
passed  the  membranous  portion  of  the  urethra, 
which  w^ill  be  indicated  when  the  long  axis  of  the 
catheter  is  at  45°  from  the  vertical,  showing  that  the 
triangular  ligament  has  been  passed,  and  the  injec- 
tion then  made.  Strong  injections  may  be  adminis- 
tered in  this  way,  nitrate  of  silver  being  most  fre- 
quently employed  in  strengths  ranging  from  1  to  10 
per  cent.  If  properly  applied  none  of  the  injection 
will  return.     (F.) 

CHRONIC  URETHRITIS— GLEET. 

In  not  a  few  cases  of  chronic  urethritis,  local  meas- 
ures are  contra-indicated,  as  frequently  the  prolonged 
use  of  injections  and  balsamic  preparations  tend  to 
perpetuate  the  gleet;  in  others,  however,  local  ap- 
plications in  conjunction  with  treatment  directed 
towards  the  improvement  of  the  general  health  are 
of  great  advantage.  Restoration  of  the  normal 
calibre  of  the  urethra,  the  cure  of  the  catarrh  and  the 
healing  of  localized  areas  of  inflammation  are  the  es- 
sential points  in  the  treatment  of  this  condition. 

The  first  step  is  to  examine  the  urethra  and  thus 
ascertain  if  possible  the  local  cause  of  the  diflftculty. 
For  this  purpose  the  bulbous  flexible  French  bougies 
or  the  endoscope  may  be  used. 


680  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Chronic  urethral  inflammation  is  divided  into  an- 
terior and  posterior  chronic  urethritis. 

Local  Treatment  for  Anterior  Chronic  Urethritis. 

Meatotomy: — When  the  meatus  is  contracted,  that 
is,  wdll  not  admit  of  the  passage  of  a  sound  the  nor- 
mal size  of  the  urethra,  the  contracted  condition  will 
often  act  as  a  source  of  irritation  and  perpetuate  the 
diseased  condition.  Meatotomy  is  then  advised,  fol- 
lowed by  flushing  the  canal  with  mild  antiseptic 
solutions  and  the  passage  of  a  sound.  To  be  re- 
peated every  two  or  three  days,  according  to  the 
amount  of  reaction.  Cure  under  these  conditions 
may  usually  be  expected  in  from  two  to  six  weeks. 
(W.  M.) 

Nitrate  of  Silver: — Most  valuable;  inject  10  drops 
of  a  1  per  cent,  solution  every  third  daj',  increasing 
the  strength  up  to  5  to  10  per  cent.,  very  exception- 
ally the  latter.  It  is  most  effective  in  solutions  from 
1  to  5  per  cent,  and  is  especially  indicated  when  there 
is  discharge  from  the  posterior  part  of  the  urethra 
v^ith  urgent  desire  to  urinate  and  pain  on  orgasm. 
(W.  M.) 

Acetate  of  Lead : — 15  drops  of  a  saturated  solu- 
tion in  4  ounces  of  water,  hot  as  can  be  borne,  inject- 
ed for  about  fifteen  minutes,  night  and  morning,  is 
effective. 

Strong  caustic  and  astringent  applications  are 
recommended  when  other  measures  have  failed.  It 
is  absolutely  essential  to  determine  the  precise  loca- 
tion of  the  diseased  area,  and  to  apply  the  remedy 
with  caution,  taking  care  not  to  leave  an  excess  of 
the  caustic  fluid  on  the  mucous  membrane.     Nitrate 


URETHRITIS.  681 

of  Silver  fixed  upon  the  end  of  a  blunt  probe  and 
touched  cautiously  to  the  spot,  or  a  solution  of  Sul- 
phate of  Copper,  gr.  xxx— 3j— 5j,  may  be  thus  em- 
ployed.    (B.  H.) 

In  some  cases  the  endoscope,  although  apparently 
indicated,  gives  negative  results  or  aggravates  the 
condition;  under  these  circumstances  injections  or 
dilatation  should  be  substituted. 

Local  Treatment  of  Posterior  Chronic  Urethritis. 

When  the  inflammatory  condition  has  extended  to 
the  posterior  portion  of  the  urethra,  deep  injections 
or  irrigations  are  necessary.  The  instrument  of 
Ultzmann  or  one  of  its  modifications  should  be  used 
with  one  of  the  following  solutions : 

Bichloride  of  Mercury,  1-10,000. 

Carbolic  Acid,  1-200. 

Nitrate  of  Silver,  1-5000. 

Potass.  Permang.,  1—5000. 

Dobell's  Solution. 

Injections  can  be  repeated  daily  for  tw^o  v^eeks  or 
until  shreds  disappear  from  the  urine,  then  every 
second  or  third  day,  gradually  discontinuing.  If 
the  solutions  are  well  borne  they  should  be  increased 
in  strength  up  to  1-2000  of  the  bichloride,  1-1500 
of  the  silver,  and  1—1000  of  the  permanganate,  and 
every  third  day  a  full-sized  sound  is  to  be  passed. 
(W.  M.) 

Thallin  Sulphate: — This  remedy  in  15  to  20  per 
cent,  solutions  is  preferred  by  some  surgeons  as  the 
best  astringent  and  antiseptic  application  for  gen- 
eral use  in  the  posterior  urethra.  Solutions  of  this 
strength  are  for  direct  application  and  not  for  injec- 
jection  or  irrigation.    They  may  be  alternated  with 


682    DIGEST  OF  EXTERNAL  THERAPEUTICS. 

irrigations  of  nitrate  of  silver  or  permanganate  of 
potassium.     (B.  H.) 

Instillations*: — There  are  of  especial  service;  the 
remedies  which  have  been  effective  administered  in 
this  manner  are  of  a  stimulating  and  astringent 
character. 

Stimulating  applications  are  indicated  v^hen  the 
endoscope  reveals  the  presence  of  localized  areas  of 
hyper^emia,  erosions,  inflammation  and  infiltration 
of  the  follicles.  The  following  remedies  of  this  nature 
are  for  use  by  direct  application  through  the  urethro- 
scope : 

Hamamelis: — The  pure  fluid  extract  is  said  to 
constitute  one  of  the  best  local  remedial  agents  w^hen 
applied  with  a  cotton  \vrapped  probe  through  the 
endoscope.  This  will  never  be  found  too  strong  ap- 
plied in  this  manner,  v^hereas  the  same  remedy  used 
as  a  25  per  cent,  injection  w^ill  cause  pain  and  incon- 
venience.    (B.  H.) 

Nitrate  of  Silver: — A  solution  of  gr.  x-gj  is  the 
best  application  in  superficial  catarrh  and  inflamma- 
tion of  the  urethral  follicles  in  the  earlier  stages. 

Solutions  of  Copper  sulphate,  or  Carbolic  acid  and 
Iodine,  equal  parts  of  a  1  to  10  per  cent,  solution, 
maj^  be  used  when  nitrate  of  silver  is  ineffective  or 
causes  undue  irritation  of  the  bladder.  Solutions  of 
Mercuric  bichloride  are  also  used.  The  stronger  the 
solution  the  fewer  drops  applied.  A  small  amount 
of  urine  should  be  allowed  to  remain  in  the  bladder 
in  order  to  dilute  or  neutralize  the  medicament, 
should  any  portion  flow  into  the  bladder. 

*NoTE. — For  the  method  of  application  of  Irrigation  and  In- 
stillation see  Acute  Urethritis. 


URETHRITIS.  683 

Astringent  injections,  such  as  Alum,  Zinc,  Sul- 
phate, and  Carbolic  Acid,  are  of  service  after  the  use 
of  the  endoscope  for  the  bleeding  and  ardor  urinae. 
(W.  M.) 

Passage  of  the  Cold  Steel  Sound: — This  will  act 
favorably  in  a  large  proportion  of  cases  in  dispersing 
granulations  and  infiltration,  in  emptying  pus  dis- 
tended follicles,  and  generally  tone  up  the  mucous 
membrane.     (Cltn.) 

Rectal  Douches: — When  there  is  irritability  of  the 
bladder  or  sexual  neuroses,  copious  rectal  douches 
may  be  employed  with  benefit.     (W.  M.) 

Iodine  and  Glycerine  : — From  3  to  10  grains  of  the 
former  to  1  ounce  of  the  latter,  is  used  for  painting 
the  urethra  through  the  endoscope;  stronger  solu- 
tions must  be  used  with  caution.     (B.  H.) 

Excellent  results  are  claimed  for  the  following  com- 
binations, w^hich  are  introduced  through  the  endo- 
scopic tube : 

|i.    lodoformi,  ^iv. 

Tr.  Benzoin.  Comp., 

Balsam,  Peruviani,  aa  ^j. 

M. 

Or, 

^.    lodi  Resublimati,  gr.  xx. 

Eucalyptoli.  gr.  ij. 

Potass.  lodidi,  gr.  ij. 

Acid.  Carbolici,  gr.  ss. 

Boroglyceridi,  q.  s.  ad  Jij. 

M.  (B.  H.) 

Ointments  are  often  beneficial.  The  ointment  is 
smeared  upon  a  warm  sound,  which  is  allowed  to 
cool  before  introduction,  thus  causing  it  to  adhere. 
The  foUow^ing  are  recommended : 

9;.    Ichthyoli,  gr.  xlviij. 

Lanolini,  5j. 

M. 


684        DIGEST  OF   EXTERNAL  THERAPEUTICS. 

Or, 

^.    Argent.  Nitratis,  gr.  v. 

Balsam.  Peruviani,  gr.  x. 

Cerse  Flavse,  gr.  x. 

Ol.  Theobromae,  §j. 
M. 
Melt  over  water  bath. 

Or, 

9^.    Creolini, 

Lanolini, 

01.  Olivae, 
M. 

Or, 

?fc.    Potass.  lodidi, 
lodi, 

Ol.  Olivae, 
Lanolini, 


M. 


M.v— XV. 

3J. 

3SS. 

(W. 

M.) 

3SS. 

gr.  V. 

3SS. 

(W. 

M.) 

Strictures,  which  are  often  the  cause  of  chronic 
urethral  discharge,  should  receive  appropriate  surgi- 
cal treatment. 

URETHRITIS  IN  FEMALES. 

Tannic  Acid: — Bougies,  covered  with  this  agent, 
according  to  Dr.  Hicks,  constitute  one  of  the  most 
efficient  means  of  treatment  in  the  specific  form. 

Resorcin: — Injections  of  3  per  cent,  solution  are 
employed.  After  the  discharge  has  diminished,  which 
is  usually  the  case  in  three  or  four  da3^s,  increase  the 
number  of  injections  to  three  or  four  a  day,  and  one 
at  night.  Continue  injections  for  some  time  after 
cessation  of  the  discharge. 

Argentamine: — For  urethral  injection  employ  solu- 
tions of  1-2000.    This  remedy  is  more  effectual  in 


URINE,   RETENTION  OF.  685 

the  gonorrhoeal  forms  than  nitrate  of  silver.  (M.  R., 
11,  21,  96.) 

Zinc  Sulphate: — A  crayon  of  the  sulphate  inserted 
into  the  urethra  has  been  used  successfully  in  chronic 
forms.    (Al.) 

Lavage  of  Urethra,  w^ith  solutions  of  Corrosive 
Sublimate,  1-2000,  or  Potass.  Permang.,  1-250, 
have  proved  of  service.     (Sj.) 

GONORRHCBA     IN    FEMALES.    See    Gonorrhoeal 
Vaginitis. 


URINE,  RETENTION  OF. 

Catheterize  the  patient  at  once.  If  not  successful 
try  Hot  Sitz  Baths,  Hot  Fomentations  to  perineum 
and  hypogastrium,  or  Hot  Enemata.  (Rd.)  Allow 
patient  to  hear  water  run  from  faucet. 

Pressure  Over  Suprapubic  Region: — If  the  reten- 
tion is  the  result  of  spinal  disease  the  urine  may 
sometimes  be  expelled  by  pressure  over  the  supra- 
pubic region  without  the  use  of  the  catheter. 

Aspiration: — When  all  other  means  fail  use  aspira- 
tor or  trocar  canula.     (CI.) 


URTICARIA. 

In  addition  to  the  following  the  reader  is  referred 
to  Pruritus : 

Cold  ^A^ater: — Often  relieves  alone  or  with  alcohol. 
Chloroform: — 5J,  with  alcohol  or  cold  cream  §j. 


686  DIGEST   OF   EXTERNAL   THERAPEUTICS, 

Camphor: — McCall  Anderson's  powder.  See  Ery- 
thema. 

Chloral: — giij,  aqua  laurocerasi  5viij. 

Menthol: — About  20  grains  to  olive  oil  1  ounce,  or 
an  ethereal  solution,  a  drachm  to  the  ounce. 

Carbolic  Acid: — ^iij,  glycerine  5J,  water  Oj. 

Benzoic  Acid: — Saturated  solution,  or  gr.  x,  water^ 

^- 
Alumnol: — 10  per  cent,  solution.     (F.) 

The  following  pomade  is  recommended  by  Brocq : 

?fc.    Acid.  Carbolici,  gr.  xv. 

Ess.  Menthae  Pip.,  M.  xv. 

Zinc.  Oxidi,  5iij- 

Lanolini,  gss. 

Vaselini,  ad  gij. 
M. 

Sig.     Before   applying  the   above,    use  lotions  of  chloral  in 
Cologne  water. 

Bathing  the  parts  with  dilutions  of  Extract  of 
W^itch  Hazel  or  Lemon  Juice,  solutions  of  Soda. 
Bicarbonate,  or  Salts  of  Potassium,  or  Ammonia, 
or  equal  parts  of  Lime  Water,  Laurel  Water,  and 
Glycerine  occasionally  affords  relief. 

Change  of  climate  in  obstinate  cases  is  often  bene- 
ficial. 


UVULA,  RELAXED  OR  ELONGATED. 

Astringent  gargles  of  Alum  or  Tannin,  and  appli- 
cations of  Nitrate  of  Silver  will  prove  useful  pallia- 
tives. 

Some  claim  that  Excision  is  the  sole  method  by 


VAGINISMUS.  687 

which  a  permanent  cure  can  be  eifected.  Care  should 
be  observed  to  excise  onlv  the  mucous  membrane. 
(Iv.) 


VAGINISMUS. 

As  this  is  a  symptom  of  various  diseased  condi- 
tions aifecting  the  genital  track  and  surrounding 
parts,  an  examination  should  be  made  in  order  to 
locate  the  cause  and  thereb}^  determine  appropriate 
treatment. 

The  morbid  conditions  which  will  give  rise  to  this 
affection  are  :  Urethral  caruncle,  inflammation  and 
fissures  of  hymen,  imperforate  hymen,  vaginal  in- 
flammations and  erosions,  vulvar  inflammation, 
erosion  and  fissures,  rectal  fissures,  cervical  lacera- 
tions, displacements,  ovarian  prolapsus,  peri-uterine 
inflammation  and  exudations.  The  local  treatment, 
therefore,  covers  a  wide  range. 

Applications  of  Belladonna  ointment,  and  W^arm 
Sitz  Baths  are  sometimes  useful.  The  following  sup- 
pository, for  its  astringent  and  sedative  effects,  is 
recommended  to  allay  irritation  : 

^.    Ext.  Kramerise,  gr.  iss. 

Morph.  Hydrochloratis,  gr.  ^. 

Ol.  Theobromae,  3J. 
M.  (T.,98.) 

Cocaine: — 1  to  5  per  cent,  solutions,  is  useftil  for 
application  in  hj^pertesthesic  conditions  after  local 
inflammations  have  been  subdued. 

Faradism: — The  application  of  the  secondary  fara- 
dic  current  of  tension  with  the  long  fine  w^ire  will 
sometimes  do  good.     (K.  C.) 


688  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Galvanism: — A  mild  current,  with  the  positive  elec- 
trode in  the  vagina  and  the  negative  over  the  hypo- 
gastrium,  has  been  administered  with  good  effect. 
(Sw.) 

Dilatation  : — Slov^-  and  cautious  dilatation,  com- 
mencing with  glass  plugs  sufficiently  small  to  be  in- 
troduced without  pain,  constitutes  a  useful  method 
of  treatment ;  if  the  stretching  go  too  far  it  wall 
cause  pain  and  relapse.     (W.  C.) 


VAGINITIS. 

See  also  LeucorrhcEa. 

SIMPLE  VAGINITIS. 

Borax: — Copious  douches  of  a  saturated  solution 
with  rest  and  mild  cathartics  w^ill  cure  most  acute 
cases.     (K.  C.) 

Thiol: — Tampons  saturated  with  a  10  to  20  per 
cent,  solution  in  glycerine  placed  in  vagina  have 
been  used  with  success. 

Marshmallow: — Injections  of  the  decoction  are 
used  in  cases  of  mild  irritation.     (Al.) 

Formal : — Injections  of  a  tablespooful  of  a  10  per 
cent,  solution  to  1  quart  of  water.     (T.,  96.) 

Ammonium  Chloride: — A  solution  of  3  drachms  to 
the  pint,  has  been  recommended  by  Dr.  Emmett  as 
an  injection  and  for  saturating  tampons  made  of 
strips  of  lint,  allov^ing  the  same  to  remain  in  place 
for  twenty-four  hours. 

Nitrate  of  Silver: — In  chronic  forms  vv^ash  out  the 
vagina  with  soap  and  water  and  paint  through  a 
speculum  the  entire  surface  with  a  nitrate  of  silver 


VA{iiNiTis.  689 

solution  1  to  20  or  full  strength ;  then  insert  a  piece 
of  sterilized  gauze.  This  the  patient  should  remove 
the  next  da^-,  and  employ  later  a  douche  of  \varm 
saturated  solution  of  borax ;  afterwards  repeat  the 
application  of  nitrate  of  silver.  This  may  be  done 
daily  or  every  other  day.     (K.  C.) 

Tannin : — The  glycerite  is  very  effective  in  chronic 
forms  in  children.     (Al.) 

Lysol: — V-i  to  1  percent,  solutions  as  douches  fol- 
lowed by  non-irritating  antiseptic  powders,  such  as 
bismuth,  boro-phenate,  are  recommended  for  senile 
vaginitis.     (Gld.) 

Potass.  Permang.: — Douches  passed  through  a  soft 
rubber  catheter  are  recommended  for  vulvo-vaginitis 
in  young  girls.  Commence  \vith  solutions  of  1-2000 
and  graduallj'  increase  to  1-1000  and  even  stronger. 
The  discharge  maj^  be  increased  at  first,  but  soon 
subsides.     (H.) 

GONORRHCBAL  VAGINITIS. 

The  external  parts  should  be  bathed  with  solu- 
tions of  Calendula  or  Borax,  dried  with  absorbent 
cotton,  and  dusted  with  Bismuth  Subnitrate  or 
Oleate  of  Zinc.     (CI.) 

Bichloride  of  Mercury  : — Hot  vaginal  douches  of  a 
1-20,000  solution  night  and  morning.  (CI.)  Stronger 
solutions,  as  1-2000,  are  employed  for  swabbing  out 
the  parts.  As  soon  as  the  more  acute  S3'mptoms 
have  subsided  energetic  treatment  is  indicated,  and 
the  following  will  be  found  effective:  First  cleanse 
the  surface  thoroughly  with  soap  and  water,  and  a 
sponge  upon  a  holder  to  reach  the  vaginal  inequali- 
ties, cocaine  being  used  if  necessar\^ ;  introduce  a  Fer- 
guson speculum  and  paint  the  entire  surface  with  a 
45 


690         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

solution  of  the  bichloride,  1—1000,  beginning  at  the 
cervix;  then  wash  with  w^arm  water,  reintroduce 
the  speculum  and  insert  sterilized  gauze  of  three  or 
four  thicknesses  to  keep  the  vaginal  walls  apart  and 
permit  of  free  drainage.  This  treatment  should  be 
repeated  daily.     (K.  C.) 

For  the  urethritis,  w^hich  occurs  as  a  complication, 
first  inject  a  4  per  cent,  solution  of  cocaine,  then, 
w^hile  making  a  little  pressure  upon  the  vesical  end  of 
the  urethra,  introduce  a  small  glass  nozzle  and  irri- 
gate the  canal  with  a  solution  of  the  bichloride  of  1- 
20,000.  This  may  be  repeated  every  day  if  neces- 
sary.    (K.  C.) 

Formalin: — Has  been  strongh^  recommended  by 
recent  writers;  the  vulva  should  be  washed  with  a 
1—1000  solution,  and  before  using  the  speculum 
wash  out  the  vagina  with  a  2  to  3  per  cent,  solu- 
tion. Swab  out  the  cervical  canal  with  1—500,  and 
if  the  cervix  is  ulcerated  apply  a  tampon  saturated 
with  1-1000.     (T.,  98.) 

Lysol: — Free  irrigation  of  a  1  per  cent,  solution  is 
much  used.     (T.,  96.) 

Tannin  and  Alum : — Equal  parts,  a  tablespoonful 
of  the  mixture  to  a  quart  of  Avater  as  a  douche, 
forms,  it  is  claimed,  when  combined  \vith  the  proper 
hygienic  and  therapeutic  measures,  one  of  the  most 
effective  local  remedies.  In  pregnant  women  the 
tannin  should  be  reduced,  making  1  part  to  4  to  5  of 
alum.  (F.)  Powdered  tannin  or  alum  is  useful  for 
dusting  on  granulations  after  the  third  week.     (CI.) 

Sodium  Formate: — ^  to  1  per  cent,  solutions  are 
used.     (T.,  96.) 

Bismuth:  —  In  vaginal  capsules,  is  recommended 
when  the  passage  of  the  speculum  is  prevented  on 


VAGINITIS.  691 

account  of  sensitiveness  of  the  parts.  When  instru- 
mentation is  possible  the  daily  application  of  tam- 
pons soaked  in  glycerine  or  boroglyceride  with  half 
a  drachm  of  bismuth  has  good  results. 

Argentamine: — Solutions  of  1-1000  as  vaginal  in- 
jections are  said  by  recent  observers  to  act  better 
than  those  of  nitrate  of  silver.     (M.  R.,  11,  21,  96.) 

Nitrate  of  Silver: — Solutions  of  2  to  40  grains  to 
the  ounce  are  effective  after  the  third  week  for  the 
granulations  remaining  in  the  vagina  or  cul-de-sac. 
(CI.)  Strong  solutions,  such  as  20  grains  to  the 
ounce,  are  used  for  inveterate  cases,  and  may  be  em- 
ployed in  the  following  manner :  Pour  the  solution 
into  a  hollow  dish,  introduce  a  Sims  speculum,  and 
w^ith  a  cotton  swab  on  a  stick  apply  the  solution 
over  the  whole  surface  of  the  mucous  membrane  of 
the  vagina,  cervix  and  vulva ;  the  pain  is  only  tem- 
porary%  but  cocaine  may  be  first  applied  ;  as  soon  as 
the  surface  is  dry,  it  should  be  anointed  w^ith  vase- 
line and  a  small  tampon  inserted.  Douches  should 
follow  each  fresh  dressing.  (Sw.)  Stronger  solutions 
are  used,  even  up  to  the  saturated.  (K.  C.)  The 
same  remedy  is  an  excellent  application  for  the  per- 
sistence of  the  disease  in  the  ducts  and  glands  of 
Skene ;  the  finger  is  introduced  into  the  vagina,  and 
by  pressing  and  drawing  forward  along  the  course 
of  the  urethra,  a  drop  of  pus  wall  exude ;  this  condi- 
tion may  be  removed  by  injecting  with  a  hypodermic 
syringe  solutions  of  4  to  40  grains  to  the  ounce. 
(CI.) 

Picric  Acid: — Solutions  of  1-1000  are  effective  for 
treating  the  glands  of  Skene,  and  may  be  employed 
in  the  same  way  as  nitrate  of  silver.     (CI.) 

Iodine  : — The  tincture  painted  on  the  vaginal  wall 


692  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

in  the  latter  stage  of  the  disease  is  useful  when 
stimulation  is  indicated.     (K.  C.) 

Gallobromal: — 5  per  cent,  solutions  for  urethritis 
are  recommended,  injections  being  made  into  the 
bladder.  The  exteral  parts  maj^  be  swabbed  with  a 
20  per  cent,  solution.     (Sj.) 

Zinc  Oleatc: — Equal  parts,  with  iodoform  make  an 
excellent  insufflating  powder  when  the  surfaces  are 
excoriated.  The  oleate  should  be  made  with  Castile 
soap.    (Sw.) 


VARICELLA. 

Bathe  the  patient  daily  in  Carbolized  Water  and 
keep  the  skin  clean.  Applj^  inunctions  of  Vaseline, 
Camphorated  Oil  or  thin  Starch  to  relieve  the  itch- 
ing.    (Rd.) 

Caution  must  be  exercised  to  prevent  any  injury  to 
the  eruption  on  the  face.  If  there  is  much  inflamma- 
tion about  the  base  of  the  eruption  points  appl3^  lint 
saturated  with  a  solution  of  Calendula,  Hydrastis 
or  Arnica.     (Gn.) 

Zinc  or  2  per  cent.  Ichthyol  Ointment,  may  be  ap- 
plied to  the  crusts  on  the  face.     (An.) 


VARICOCELE. 

Cold  Douches: — Applied  to  the  scrotum  and  peri- 
neum, containing  10  per  cent,  of  Tannin,  are  useful 
palliative  measures,  together  with  the  suspensory 
bandage.     (T.,  96.) 


VARICOSE  VEINS.  693 

Hamamelis: — Forms  a  useful  lotion  when  used  in 
conjunction  with  Cold  ^A/^ate^  sponging. 

Ergotine : — The  hypodermic  injection  of  this  drug 
is  said  to  be  effective.  About  2  grains  of  the  extract 
is  administered  for  a  dose.  Bartholow,  w^ho  com- 
mends the  procedure,  says:  "The  needle  is  inserted 
so  that  its  point  will  rest  among  the  dilated  veins ; 
great  care  must  be  exercised,  however,  not  to  punc- 
ture them.  Very  severe  pain  follows  and  possibly 
faintness,  but  these  effects  subside  in  a  few  hours  un- 
less considerable  swelling  ensues,  which  is  quite 
usual.  A  single  injection  may  cure  a  very  extensive 
varicocele;  more  than  two  are  rarely  necessary." 
This  procedure  is  looked  upon  with  disfavor  by 
other  authorities. 

Operation : — Comparatively  few  cases  will  require 
surgical  interference;  a  well  adjusted  Suspensory 
worn  when  in  the  erect  posture  will  usually  be  all 
that  is  necessary.  But  when  palliative  measures 
fail,  an  operation  is  demanded  for  radical  cure. 
There  are  two  methods  generally  employed,  subcuta- 
neous ligation  (Keyes),  and  ligation  by  the  open 
method ;  the  latter  is  the  better.     (CI.) 


VARICOSE   VEINS. 

Hamamelis  : — Applied  as  a  lotion  on  compresses 
covered  with  oiled  silk,  held  in  position  by  a  well  ap- 
plied bandage,  is  often  effective.  Use  1  part  of  the 
tincture  to  6  parts  of  water.     (Rd.) 

Moderate  Compression:— Accurately  fitting  band- 
ages or  elastic  stockings  may  be  applied  so  as  to 
afford  that  support  to  the  blood  which  the  valves 


694         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

can  no  longer  give,  and  to  prevent  increased  disten- 
sion. The  pressure  should  be  very  gentle  and  uni- 
form, and  applied  in  the  morning,  before  the  patient 
puts  his  feet  on  the  floor,  and  maintained  until  he  re- 
tires to  bed.  Should  only  a  small  portion  of  a  vein  be 
enlarged,  a  piece  of  strapping  plaster  may  afford  the 
requisite  support.  Prolonged  exercise  or  standing 
should  be  avoided.  After  taking  moderate  exercise, 
the  limb  should  be  raised,  and  maintained  in  a  hori- 
zontal posture.  Standing  is  more  unfavorable  than 
■walking.  The  leg  should  be  well  washed  and  rubbed 
quite  dry  every  morning.     (Rd.) 

Perchloride  of  Iron: — 1  part  to  3  of  water;  take 
strips  of  folded  cotton  wet  with  the  solution  and 
apply  over  enlarged  vein ;  cover  w^ith  oiled  silk  and 
apply  bandage  and  renew  daily.  Many  cases  are 
said  to  be  affected  favorably.     (Bt.) 

Chloride  of  Barium: — Prof  Robert,  of  Dorprat, 
recommends  the  use  of  barium  applied  in  the  form  of 
an  ointment  to  dilated  cutaneous  veins  in  the  pro- 
portion of  1  drachm  to  lanolin  1  ounce.  The  oint- 
ment is  to  be  rubbed  on  the  aifected  part  three  times 
a  day.     (Sm.) 

Intravenous  injections  to  produce  coagula  are  dan- 
gerous; though  they  have  been  practiced  with  suc- 
cess, they  are  generally  condemned.  The  use  of 
Vienna  paste  and  similar  caustics  is  obsolete.  The 
only  method  of  radical  cure  is  by  Subcutaneous 
Ligation. 


VARIOLA. 

There  are  three  important  indications  for  external 
treatment :  Exclusion  of  air  from  surface  of  the  skin, 


VARIOLA.  695 

keeping  the  parts  permanently  moist  to  prevent 
hardening  of  the  scabs,  and  lessening  of  local  irrita- 
tion. 

Vaccination:  —  Advisable  as  soon  as  possible  in 
order  to  change  the  disease  to  varioloid.     (Bt.) 

Exclusion  of  Light: — There  is  a  prevailing  idea 
that  light  should  be  excluded  from  the  face  to  pre- 
vent pitting,  though  there  are  some  doubts  as  to  the 
correctness  of  this  view ;  it  is,  however,  an  expedient 
recommended  by  many  writers,  especially'-  the  older. 
Masks  may  be  worn  for  this  purpose. 

Boric  Acid : — Applications  of  a  solution,  1  drachm 
to  the  pint  of  water,  bj^  means  of  saturated  com- 
presses covered  with  oiled  silk  and  frequently 
changed,  is,  together  with  the  Exclusion  of  Sun- 
light, a  method  much  practiced.  A  solution  of  1 
drachm  to  1^  ounces  of  glycerine  applied  to  the  face 
and  pharynx  by  means  of  a  brush  is  also  employed. 
(T.  C,  Vol.  XIII.) 

Carbolic  Acid  : — This  remedy  is  mentioned  by  most 
writers  and  is  used  in  various  strengths.  It  may  be 
applied  to  the  face  dissolved  in  olive  oil. 

In  Germany  the  following  paste  is  much  used : 

Carbolic  Acid,  4  to  lo  parts. 

Olive  Oil,  40  parts. 

Prepared  Chalk,  60  parts. 

Spread  on  linen  and  apply  to  the  parts  where  the  eruption  is  the 
most  severe;  change  every  twelve  hours.     (T.  C,  Vol.  XIII.) 

The  follow^ing  is  said  to  relieve  the  itching  at  once : 

Carbolic  Acid  (Crystals),  i  part. 

Camphor,  3  parts. 

"Vaseline,  3  to  5  parts. 

(F.) 
Flexible    Collodion;— If   applied    to    the    pustules 


696  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

early  \vill  have  a  good  effect  and  protect  the  face 
from  the  hands.  (F.)  If  appHed  late  it  will  do  in- 
jury by  causing  the  pus  to  burrow. 

At  the  London  Smallpox  Hospital,  Mr.  Marson's 
treatment  was  to  wait  until  the  pustules  had  burst 
and  then  apply  Olive  Oil  or  Glycerine  and  Rose 
^A^ate^,  1—3.  He  also  recommended  Cold  Cream, 
Zinc  Oxide  Ointment,  or  Carron  Oil. 

Hydrarg.  Bichlorid.: — Compresses  wet  with  a  solu- 
tion of  gr.  ij— iv,  water  gvj  ;  or, 

9;.    Hydrarg.  Bichlorid., 

Acid.  Citricij  aa  gr.  xv. 

Alcoholis  (90  per  cent.),  M.lxxx. 

Etheris,  q.  s.  ad  ^iss. 

M. 

Sig.  Spray  the  face  for  a  minute  three  or  four  times  a  day 
until  desication  takes  place;  protect  the  eyes  during  the 
application.     (T.'  C. ,  Vol.  XIII. ) 

Cold  Compresses:  —  A  light  mask  of  lint  thor- 
oughly soaked  in  a  mixture  of  ice  water  and  gly- 
cerine 3J— §j,  and  covered  with  oiled  silk,  is  preferred 
by  Dr.  J.  W.  Moore.  It  is  also  recommended  for  the 
relief  of  pain  and  sw^elling. 

Salicylic  Acid: — A  paste  made  with  3  parts  of  the 
acid,  30  of  starch,  and  70  of  glycerine,  applied  to  the 
face  by  means  of  a  mask ;  also  to  other  parts  where 
the  eruption  is  marked. 

Ihle's   Paste: — A  mixture  of  resorcin   10  grains, 
w^ith  2  drachms  each  of  powdered  starch,  oxide  of 
zinc,  lanolin,  and  vaseline,  is  suitable  for  some  cases. 
(T.  C,  Vol.  XIII.) 

Antiseptic  and  Astringent  Dusting  Powders: — In 
the  earlier  stages  of  the  eruption  will  possibly  relieve 
the  heat  and  irritation.    For  this  purpose  the  follow- 


VARIOLA.  697 

ing  may  be  mentioned :    Boric  Acid,  Subgallate  of 
Bismuth,  or, 

9;.    Acid.  Carbolici,  ^ss. 

Zinc.  Oxidi,  ^j. 

Pulv.  Lycopodii,  ^j. 

M.  (T.  C,  Vol.  XIII.) 

Aristol: — 15  or  20  parts  with  100  of  vaseline,  or 
15  parts  with  100  of  talc. 

Labarraque's  Solution: — 1  percent.     (L.  T.) 

Cold  Cream  and  Flour: — Made  into  a  thick  paste. 
(Rd.) 

Bismuth  or  Zinc  Oxide: — Dusted  on  after  the  ap- 
plication of  glycerine  or  olive  oil.     (Bt.) 

Iodoform: — a;j,  collodion  |j ;  paint  on  pustules  fre- 
quently for  hastening  the  drying  and  preventing  the 
extension  of  pustulation.     (T.,  98.) 

Linseed  Meal  Poultices: — Sprinkled  with  Iodoform 
can  best  accomplish  early  separation  of  the  crusts 
whether  on  the  face,  scalp  or  elsewhere.  A  mask  of 
the  poultice  may  be  made  for  the  face,  spreading  a 
thin  layer  on  lint  and  applying  a  little  vaseline  on 
which  iodoform  has  been  sprinkled;  change  every 
two  hours.     (T.  C,  Vol.  XIII.) 

Sponging: — This  is  both  useful  and  agreeable  and 
should  be  used  in  most  cases.  Warm  water  with  a 
little  prepared  carbolic  acid  may  be  employed.    (Rd.) 

Hot  Baths; — May  be  used  when  it  is  desired  to 
hasten  the  appearance  of  the  eruption,  (T.  C,  Vol. 
XIII.) 

The  Prolonged  Warm  Bath  is  recommended  by 
Skoda,  Hebra  and  others,  for  desperate  cases.  The 
patient  may  be  kept  in  the  bath  for  seven  hours 
daily.  Great  relief  has  followed  this  procedure  in 
what  appeared  to  be  hopeless  cases. 


698  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Cold  Baths: — Indicated  for  hyperpyrexia.     (F.) 

Gloves  may  be  worn  in  order  to  prevent  injury  to 
the  face  bj^  scratching,  especially  in  sleep.  Children 
may  have  the  hands  loosely  bound.     (L,  T.) 

The  mouth  should  be  frequently  and  carefully 
cleansed. 

Many  other  local  remedial  measures  have  been 
suggested,  but  the  above  are  those .  which  appear  to 
have  met  with  more  general  approval.  Finsen  has 
revived  the  mediaeval  treatment  of  red  light,  the 
briefest  exposure  to  daylight  being  regarded  as  liable 
to  produce  suppuration.  Exclusion  of  chemical  rays 
must  be  absolute,  even  the  curtains  being  red.  Pack- 
ing for  an  hour  in  blankets  saturated  in  IV^  pints  of 
warmed,  not  boiled,  milk  have,  it  is  claimed,  been 
successful  in  arresting  the  progress  of  the  disease. 

Ventilation: — This  is  a  matter  of  the  greatest  im- 
portance. The  exit  of  the  contaminated  air  and  the 
entrance  of  fresh  should  be  secured.  Some  observers 
advocate  the  use  of  tents,  or  opening  the  windows 
and  protecting  the  patient  w^ith  extra  blankets  and 
shielding  from  draughts. 


VOMITING  OF  PREGNANCY. 

Exercise  care  in  brushing  the  teeth,  as  in  some 
cases  this  produces  vomiting. 

Ether  or  Chloroform  Spray  against  the  epigas- 
trium; Collodion  painted  over  epigastrium;  Me- 
chanical Support  of  uterus  by  pessaries  or  cotton, 
changing  cotton  daily ;  irrigation  with  a  solution  of 
Potassium  Bromide,  gr.  xx-xl-^j ;  the  Recumbent 
Posture  with  the  head  lower  than  the  bodj'  (Bt.), 


VULVITIS.  699 

and  Cold  to  the  spine  by  means  of  ice  bags,  are  all 
measures  which  may  be  given  a  trial.    (Rd.) 

Vesication: — Applied  over  the  4th  and  5th  dorsal 
vertebrae  is  said  to  have  given  brilliant  results,  one 
application  being  sufficient. 

Icythhol: — Applied  on  tampons  is  effective  in  ob- 
stinate cases.     (T.,  98.) 

Slight  Dilatation  of  the  Os: — This  procedure  per- 
formed with  great  care  is  frequently  attended  with 
benefit.  The  vagina  should  be  first  douched  with  a 
corrosive  sublimate  solution  of  1-5000,  and  the 
parts  rendered  anaesthetic  with  cocaine;  the  finger 
should  then  be  gently  introduced  and  moved  around 
the  cervix  with  caution.     (G.  T.) 

Electricity: — Voltaism,  with  feeble  intensity  and 
long  duration,  applied  to  the  right  pneumogastric, 
the  positive  electrode  being  placed  between  the 
clavicular  insertion  of  the  sterno-cleido-mastoid 
muscle  and  the  negative  at  the  umbilicus.  Each 
stance  should  continue  from  fifteen  to  thirty  minutes. 


VULVITIS. 

See  also  Vaginitis. 

Modem  treatment  is  exceedingly  simple,  consisting 
in  absolute  cleanliness  and  antisepsis.  Great  care 
should  be  exercised  to  keep  the  external  parts  free 
from  all  discharges*  In  young  children  the  best  plan 
is  to  have  them  thoroughly  bathed,  and  in  older  girls 
the  vagina  and  vulva  should  be  cleansed  as  though  a 
plastic  operation  was  about  to  be  performed.  No 
special  treatment  of  the  urethra  is  required.  Douches 
for  very  young  children  are  best  applied  by  means  of 


700  DIGEST   OF   EXTERNAL   THERAPEUTICS, 

a  soft  rubber  catheter.  Whilst  administering,  the 
antiseptic  fluid  may  be  brought  into  more  thorough 
contact  with  the  interstices  of  the  parts  by  ocasion- 
ally  closing  the  vaginal  orifice.  After  washing  and 
irrigating,  the  labia  should  be  kept  separated  by  a 
piece  of  lint  saturated  with  the  antiseptic  fluid. 

In  simple  varieties  of  the  disease,  strong  injections 
are  contra-indicated.  The  only  treatment  required 
w^ill  be  that  of  frequent  bathing  with  Sterilized 
"Water  and  Boric  Acid  solutions  and  dusting  with 
bland  powders  such  as  boric  acid. 

Hydrarg.  Bichlorid.: — This  agent  is  recommended 
in  various  solutions,  viz.:  1—4000  or  5000,  or  even 
10,000.  (W.  A.  E.)  For  frequent  use  as  an  injection, 
1-2000  or  5000,  and  for  occasional  application  in 
the  diphtheritic  variety  solutions  of  from  1—300  or 
500  have  also  been  recommended. 

The  following  other  solutions  constitute  usefiil 
antiseptic  douches: 

Carbolic  Acid,  1-100.  Preferable  when  there  is 
much  burning  and  itching. 

Boric  and  Salicylic  Acid,  10  grains  of  the  former 
and  5  grains  of  the  latter  to  the  ounce. 

Nitrate  of  Silver,  1-3000,  or  5000.     (W  .A.  E.) 

Lysol,  one-half  to  1  per  cent,  followed  by  bland 
powders.     (Gld.) 

For  the  disease  appearing  after  scarlet  fever  and 
measles : 

Zinc  Sulpho-Carbolate,  1  or  2-100. 

Aluminum  Aceto-Tartrate,  1  or  5-100. 

These  solutions  are  suitable  for  both  irrigation 
and  application  by  saturating  lint  and  laying  it  over 
the  part.  They  may  be  used  in  very  young  children. 
(Jac.) 


VULVITIS.  701 

Other  injections  useful  for  children  are  the  follow- 
ing : 

Carbolic  Acid,  1-200. 

Alum,  3j-0j.     (Sm.) 

Nitrate  of  Silver: — In  the  catarrhal  variety  this  re- 
lieves the  burning  and  itching.  It  may  be  applied  as 
follow^s :  First  anaesthetize  the  part  with  a  10  per 
cent,  solution  of  cocaine.  Then  apply  the  silver  solu- 
tion, 20  to  60  grains  to  the  ounce,  and  cover  with  a 
layer  of  vaseline  or  with  a  flaxseed  poultice.  A  single 
application  wall  usually  suffice ;  if  necessary,  it  may 
be  repeated  in  three  or  four  days.     (H.) 

Iodoform : — Equal  parts  with  bismuth  acts  well 
w^hen  the  discharge  is  purulent.  In  some  conditions 
an  ointment  may  be  preferred,  in  which  case  a 
drachm  to  the  ounce  may  be  used.  When  pruritus  is 
a  prominent  symptom,  cocaine  may  be  combined  as 
follows : 

9^.    lodofonni,  xv-xl. 

Cocainse  Hydrochloratis,  3ss. 

Vaselini,  ^j. 
M.  (H.) 

Lead  Acetate: — Cold  compresses  wet  in  lead  lotion 
are  usually  all  that  is  necessary  in  eczematous  varie- 
ties. 

When  the  discharge  is  profuse  the  following : 


(Alb.) 


9.    Acid.  Borici, 

3J- 

Plumb.  Acetatis, 

gr.  X 

Bismuth.  Carbonatis, 

3ij- 

Vaselini, 

ad  ^j. 

M. 

For  the  simple  dermal  variety : 

9;.    Calamin.  Praeparatae, 

gss. 

Zinc.  Oxidi, 

3ij- 

Glycerini, 

Si- 

Aq.  Rosse, 

^iij. 

M. 

(Alb.) 


702  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Lead  and  Opium  Wash : — Hare  recommends  the 
follow^ing,  applied  Avith  compresses  when  nitrate  of 
silver  fails : 

^.    T.  Opii, 

Liq.  Plumb.  Subacetatis,  aa  ^j. 

Aq.  Destill.,  Jvj. 

M.  (H.) 

When  an  astringent  is  desired  for  injection  and  irri- 
gation Tannin,  5-500,  or  Zinc  Sulphate,  1-50,  can 
be  used  with  good  effect. 

Ice  Bags  and  Hot  Fomentations  followed  by  In- 
cision and  antiseptic  Irrigation  are  indicated  when 
pus  has  formed. 

When  the  disease  takes  on  an  aphthous  type  the 
following : 

^.    Acid.  Salicylici,  3ss-j. 

Bismuth.  Subnitratis,  ,^ij. 

Glycerini,  ^j. 
M.  (H.) 

Carbolized  Oil : — This  is  sometimes  of  service,  ap- 
plied in  the  strength  of  1-60.     (Strr.) 

The  following  bland,  non-irritating,  antiseptic 
powders  are  useful  after  antisepsis:  Markosol  (Gld.), 
or  Boric  Acid  combined  with  Zinc  or  Starch,  of 
which  the  following  is  an  example : 

^.    Pulv.  Zinc.  Oxidi, 

Acid.  Boric,  aa  ^ss. 

Pulv.  Amyli,  ^j. 

M.  (Strr.) 

Sodium  Sulphite: — When  due  to  diabetic  urine, 
Hare  recommends  a  solution  of  §ss— Oj  in  conjunc- 
tion with  separation  of  the  surfaces  by  means  of 
pledgets  of  lint  medicated  with  diachylon  ointment. 

Ointments  are  useful  to  protect  the  parts  from  the 


WARTS.  703 

irritating  vaginal  discharges.  Cold  Cream,  Zinc 
Oxide  Ointment,  Benzoated  Lard  1  drachm,  with 
zinc  oxide  ointment  1  ounce,  may  serve  this  purpose. 
The  same  may  also  be  used  to  relieve  the  heat  and 
dryness  of  the  part.     (H.) 

In  the  gonorrhoeal  variety,  rest  and  elevation  of 
the  parts  are  absoluteh'  essential.  The  affected 
region  must  be  kept  clean  and  dry.  Washing  every 
two  hours  with  a  strong  solution  of  Soda  Bicarbon- 
ate, which  should  be  applied  gently,  the  vaginal  ori- 
fice being  separated  by  the  thumb  and  finger.  After 
irrigation,  the  parts  should  be  thoroughly  dried  and 
all  moisture  removed  by  absorbent  compress  or  old, 
clean  linen  or  similar  material.  Dusting  powders, 
such  as  those  previously  mentioned,  can  now  be 
used.  In  the  severer  forms  Hot  Baths  (not  sitz  baths), 
followed  by  Lead  and  Opium  wash  or  painting  the 
entire  vulva  with  a  solution  of  Nitrate  of  Silver,  gr. 
xl— 5J,  will  usually  effect  a  cure.  For  the  severe  burn- 
ing and  throbbing  and  inflammation.  Leeches  along 
the  groin  and  perineum  will  not  afford  relief     (Am.) 

In  chronic  cases  the  vagina  and  the  urethral 
glands  are  often  at  fault.  For  these  conditions.  Free 
Incisions  and  the  Curette  followed  by  packing  with 
Iodoform  Gauze  have  been  recommended ;  also  ex- 
cision and  the  seton;  but  the  former  measures  are 
preferable.     (Am.) 


WARTS. 

Local  treatment  will  vary  according  to  variety 
and  locality.  Small  grow^ths  may  be  removed  with 
a  pair  of  curved  scissors,  and  the  base  touched  w^ith 


704  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

nitrate  of  silver.  Larger  growths  call  for  the  Liga- 
ture or  Galvano-cautery.  Smaller  ones,  when  pedun- 
culated, may  also  be  convenientlj^  removed  by  the 
ligature.     ( Pf. ) 

Hydrarg.Bichlorid.: — Localities  which  are  the  seat 
of  the  growths  should  be  frequently  washed  with  a 
bichloride  soap  and  bathed  with  a  solution  of  1— 
2000.  This  should  precede  all  methods  of  treatment 
according  to  Van  Harlingen,  who  recommends  paint- 
ing the  part  w^ith  a  solution  in  collodion  of  from  4  to 
8  grains  to  the  ounce. 

Chromic  Acid: — A  saturated  solution  is  preferred 
by  Crocker  for  application  to  common  warts.  The 
black  crusts  should  be  removed  every  few  daj^s. 

Salicylic  Acid: — A  saturated  solution  in  alcohol, 
repeatedly  applied,  is  usuallj^  successful  for  small 
warts.    (Ck.) 

The  following  are  also  affective : 

9;.    Acid.  Salicylici,  ^ss. 

Ext.  Cannabis  Indicae,  gr.  v. 

Collodii,  ,^j. 
M. 

For  seborrhoeal  warts;  before  applying  remove 
crusts  with  vaseline,  or  with  friction  and  green  soap : 

9(.    Acid.  Salicylici,  gr.  x-xx. 

Sulphur.  Prsecipitati,  ^ss. 

Pulv.  Amyli,  gss. 

Ung.  Aq.  Rosae,  ^iv. 
M.  (Hd.) 

Thuja: — Often  useful;  apply  the  tincture  frequently 
with  a  brush.     (Rd.) 


WARTS.  705 

Caustic  Pastes: — Viz.: 

^.    Sulphuris,  ^v. 

Glycerini,  .^iss. 

Acid.  Acetici,  giiss. 

M.  (Kap.) 

Sig.     Apply  twice  daily. 

{fc.    Pulv.  Acid.  Arsenosi,  gr.  vj. 

Ung.  Hydrarg., 

Enipl.  Hydrarg.,  aa  q.  s.  ad  3ij- 

M.  (Hy.) 

Electrolysis: — Mentioned  133^  Hardaway  as  the 
best  treatment.  Complete  destruction  of  the  growth 
is  not  necessarj^  but  merely  transfixion  w^ith  the 
needle. 

Caustics: — In  addition  to  those  already  mentioned, 
the  following  are  also  used :  Potassa,  Acid  Nitrate  of 
Mercury,  Chloride  of  Zinc,  Nitric,  Hydrochloric, 
Acetic,  Glacial  Acetic, and  Carbolic  Acids.     (Duh.) 


46 


APPENDIX   I. 


MEDICINAL  BATHS. 

Acid  Baths  : 

5fc.    Acid.  Nitrici  Fortis,  g  iss. 

Acid.  Hydrochlorici  Fortis,  Jj, 

Aquae,  C.xxx. 

M. 

May  be  employed  in  pruritus,  urticaria  and  eczema 
of  the  papular  variety. 

1^.    Acid.  Muriatici,  5^- 

Aquae,  C.l. 

M. 

Acid  baths  should  be  prepared  in  a  wooden  tub 
and  administered  two  or  three  times  a  week  for  fif- 
teen or  tw^enty  minutes  at  a  time.  They  have  been 
employed  in  treating  mercurial  poisoning  and  in  cer- 
tain hepatic  diseases  with  retention  of  bile.  They 
have  been  found  to  increase  the  irritation  of  jaundice 
and  are  rarely  used  at  the  present  time. 

Alkaline  Baths: 
9:.    Sodii  Carbonatis,  ,^iv. 

Aquae,  C.xxx. 

M. 

Or, 
Jfc.    Potassii  Carbonatis,  ,^iv. 

Sodii  Carbonatis,  5"j' 

Sodii  Boratis,  .^ij. 

M. 
Add  this  powder  to  30  gallons  of  water,  with  half  a  pound  of 
starch,  which  has  been  previously  boiled,  to  make  what  is  known 
as  a  clear  starch. 


708  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

An  artificial  Vich3'  bath  maj'  be  prepared  bj'  add- 
ing 1  part  of  sodium  bicarbonate  to  600  parts  of 
"\?\rater,  and  an  artificial  Plombieres  bath  by  mixing 
the  following : 


Sodium  Carbonate, 

50  parts. 

Sodium  Chloride, 

2  parts. 

Sodium  Sulphate, 

6  parts, 

Sodium  Bicarbonate, 

2  parts. 

Gelatin, 

10  parts. 

Water, 

30, 

000  parts. 

These  baths  are  of  utility  in  chronic  vesicular  and 
squamous  skin  diseases  as  prurigo,  psoriasis  and 
ichthyosis  where  a  palliative  effect  is  desired.  In 
chorea  and  functional  nervous  disorders  they  will 
prove  of  benefit  for  their  sedative  properties.  Thej^ 
are  also  found  beneficial  in  jaundice  when  there  is 
much  itching.  Chronic  rheumatism,  gout,  and  uri- 
nary lithiasis  may  be  aided  by  their  use. 

Aromatic  Baths : — Prepared  bj''  infiising  rosemary, 
lavender,  sage,  wormwood  or  other  aromatic  herbs. 
This  bath  may  be  used  in  chlorosis  and  sometimes  in 
cachectic  conditions  as  cutaneous  excitants.  The 
recipe  of  the  official  French  code  is  500  grams  of 
aromatic  spices  dissolved  in  10  litres  of  water,  add- 
ing the  solution  to  250  litres  of  water. 

Arsenical  Baths: — Dissolve  15  to  45  grains  of  so- 
dium arsenate  and  3  ounces  of  sodium  carbonate  in 
a  bath  tub  full  of  water.  Thirtj^  baths  are  said  to 
relieve  the  articular  stiffness  and  pain  in  rheumatic 
arthritis.  Gastric  trouble  may  arise  or  the  joint 
pain  increase,  but  these  symptoms  will  disappear 
w^hen  the  sodium  bicarbonate  is  withdrawn. 

Another  formula  is : 


APPEJ 

iDIX  I. 

5fc. 

Potassii  Sulphured, 

5iv. 

Sodii  Arseniatis, 

gr.  xxx-xl, 

Aq.  Calidae, 

C.xxx. 

M. 
tor 

ax  Baths : — 

5fc. 

Sodii  Boratis, 

.^iv. 

Glycerini, 

5"J- 

M. 

Aq.  Calidae, 

C.xxx. 

709 


Bromine  Baths  : — Made  by  dissolving  20  drops  of 
bromine  and  2  ounces  of  potassium  bromide  in  30 
gallons  of  water.  Advantageous  in  syphilis  and 
squamous  skin  diseases. 

Carbolic  Acid  or  Creosote  Bath«  : — 
9^. 


Creosoti  seu  Acid.  Carbolici, 

3ij- 

Glycerini, 

5ii- 

Aquae, 

C.xxx. 

M. 

May  be  employed  in  pruritus  and  certain  forms  of 
squamous  eczema. 

Emollient  Baths: — Have  been  employed  with  good 
effect  in  cold  abscess,  lymphangitis,  phlebitis,  acute 
arthritis,  and  erythematous,  scaly  and  itching  skin 
affections. 

These  baths  may  be  prepared  as  follows,  the  pro- 
portions being  the  quantity  of  the  medicament 
stated  to  30  gallons  of  water;  bran,  2  to  6  pounds; 
linseed,  1  pound;  marshmallow,  4  pounds;  potato 
starch,  1  pound. 

Gelatin  Baths: — Dissolve  1  pound  of  gelatin  or 
common  glue  in  boiling  water  and  add  20  gallons  of 
hot  -water.  They  may  be  made  more  effective  by 
adding  1  to  2  pounds  of  bran  confined  in  a  muslin 
bag.    These  baths  have  been  recommended  in  skin 


710  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

diseases  where  nervous  excitability  is  a  prominent 
feature.  Gelatin  added  to  sulphuretted  baths  renders 
them  less  disagreeable.  The  French  code  directs  that 
500  grams  of  powdered  gelatin  be  dissolved  in  2  litres 
of  hot  water,  and  added  to  the  bath  when  required. 

Iodine  Baths: — 

5fc.    Potassii  lodidi,  3vj. 

lodi,  3iij. 

Aquae,  S^^- 

M. 
Sig.     Add  this  mixture  to  an  ordinary  bath. 

These  baths  have  been  advantageouslj^  used  in 
scrofula  in  children  and  in  syphilis  and  squamous 
skin  diseases.  For  children  the  formula  may  be 
modified  thus : 


9^.    Potassii  lodi, 

9iv. 

lodi, 

9i3- 

Aquae, 

l^- 

M. 

Sig.     Add  to  an  ordinary  bath. 

Mercurial  Baths: — 

5fe.    Hydrarg.  Bichloridi, 

5v. 

Alcoholis, 

Sij- 

Ammonii  Chloridi, 

5J. 

M. 

Sig.     This  mixture  may  be  added  to  a  bath  tub  of  water, 

This  bath  is  used  in  syphilides,  but  is  contra-indi- 
cated when  there  is  much  ulceration  for  fear  of  ab- 
sorption. Sublimate  baths  which  have  proved  use- 
ful in  infantile  syphilis  may  be  prepared  by  adding 
10  grains  of  the  bichloride  to  each  bath.  A  blanket 
should  be  tied  around  the  neck  of  the  child  to  cover 
the  bath  and  effectually^  prevent  splashing  of  the 
water  in  its  face. 


APPENDIX  I.  711 

Mercurial  Vapor  Baths  : — A  tin  case  is  furnished  by 
instrument  makers,  containing  a  small  spirit  lamp 
with  a  receptacle  over  the  flame,  on  which  15  to  30 
grains  of  calomel  are  placed.  Surrounding  this  there 
is  a  saucer-like  receptacle  Avhich  is  filled  with  boiling 
water.  The  patient  is  seated  on  a  common  cane- 
bottomed  chair,  under  which  the  apparatus  is 
placed.  The  lamp  is  then  lighted  and  the  patient 
and  chair  are  completely  enveloped  in  large  blankets. 
In  about  twenty  minutes  the  mercury  and  water 
w^ill  be  found  to  have  disappeared.  It  is  advisable 
not  to  use  a  towel,  as  the  calomel  can  be  wiped  off. 
The  bath  may  also  be  given  by  using  a  hot  air  box 
especially  constructed  for  the  purpose.  These  forms 
of  mercurial  baths  are  almost  exclusively  used  when 
the  administration  of  mercury  in  this  manner  is  de- 
sired. 

Mustard  Baths: — Prepared  by  dissolving  1  to  2 
parts  of  mustard  meal  in  600  of  warm  water.  Keep 
the  patient  only  a  brief  time  in  the  bath  to  prevent 
too  great  irritation  of  the  skin. 

These  are  used  in  the  algic  state  of  cholera  and  seri- 
ous congestion  of  the  bowels.  The  mustard  foot- 
bath, according  to  the  French  code,  is  made  by  dis- 
solving 150  grams  of  mustard  meal  in  a  suflacient 
quantity  of  water  not  above  104°  F. 

Pine  Baths. — Made  by  adding  a  decoction  of  pine 
tree  shoots  to  water,  or  by  using  the  oil  of  forest 
pine  (oleum  pini  silvestris)  in  the  proportion  of  1 
minim  to  the  gallon.  These  baths  are  useful  in  gout 
and  rheumatism,  scrofula,  skin  diseases  and  pa- 
ralysis. 

Saline  Baths: — Dissolve  8  to  10  parts  of  rock  salt 


712  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

or  sea  salt  in  300  of  water.  The  French  code  says 
5000  grams  of  sea  salt  to  300  litres  of  water. 

For  sponging  use  a  solution  of  common  salt  in  the 
proportion  of  half  a  pound  to  4  gallons  of  water. 

Sea  Baths: — These  diminish  peripheral  circulation 
and  simulate  respiration  of  pure  sea  air.  They  are 
beneficial  in  scrofulous  diathesis,  functional  nervous 
disorders  and  sometimes  in  mal-assimilation.  A  ten- 
dency to  internal  hemorrhage  is  a  contra-indication. 

Narcotic  Baths: — Boil  for  an  hour  1  part  of  poppy 
seeds,  belladonna  leaves,  hyoscyamus  leaves,  datura 
leaves  or  other  narcotic  leaves  in  10  parts  of  w^ater ; 
add  the  decoction  to  a  tub  full  of  warm  water. 
These  baths  will  be  found  useful  in  inflammation  of 
the  genito-urinary  organs,  peritonitis,  enteritis,  ex- 
ternal haemorrhoids,  etc. 

Sedative  Baths: — 1  part  of  some  sedative  herb, 
such  as  valerian,  digitaUs,  or  hemlock,  in  10  parts  of 
water.  Place  the  decoction  in  a  tub  full  of  warm 
water.  Useful  in  neurasthenia,  hysteria  and  certain 
forms  of  neuroses.  Inhalation  of  the  fumes  should 
be  prevented  by  pinning  a  sheet  around  the  patient's 
neck. 

Stimulating  Baths: — The  addition  of  alcohol,  wine, 
rum,  aromatic  alcohol  or  aromatic  vinegar  to  warm 
water  will  prove  beneficial  in  stimulating  circulation 
and  relieving  debility  and  languor.  A  useful  stimu- 
lating sponge  bath  is  as  follows :  Quinine  sulphate 
20  grains,  sea  salt  2  ounces,  hot  water  1  quart. 

Sulphur  Baths: — These  are  stimulating  and  are 
useful  in  cutaneous  eruptions,  such  as  herpes,  s^^ph- 
ilides,  scrofulous  diseases,  scabies,  psoriasis,  pityri- 
asis, acne,  and  impetigo,  etc.,  and  in  articular  rheu- 


APPENDIX  I.  713 

matism,  catarrhs,  lead  palsy,  chlorosis,  and  anaemia. 
They  are  prepared  by  mixing  the  following : 

Sodium  or  Calcium  Monosulphate,  50  parts. 

Sodium  Carbonate  or  Bicarbonate,  50  parts. 

Sodium  Chloride,  50  parts. 

Water,  300,000  parts. 

Startin's  compound  sulphur  bath  consists  of  the 
following : 

^.    Sulphur.  Prsecipitati,  ^ij. 

Sodii  Hyposulphitis,  ^j. 

Acid.  Sulphuric,  Diluti,  §ss. 

Aquae,  Oj. 
M. 

Sig..     Add  this  to  the  contents  of  the  bath  tub. 

Another  formula : 

^.    Potassii  Sulphureti,  ^iv. 

Aquae,  C.  xxx. 

M. 

Tar  Baths: — So-called  tar  baths  are  employed  for 
rubbing  the  diseased  parts  with  tar  and  foUow^ing 
this  treatment  with  an  ordinary  warm  bath. 

Baths  are  classified  according  to  temperature,  as 
follows : 


Cold,  .  .  . 
Cool,  .  .  . 
Temperate, 
Tepid,  .  . 
Warm,  .  . 
Hot,    .    .    . 


Water.  Vapor.  Air. 

45°-  65° 
65°-  75° 
75°-  85° 

85°-  92°  90°-ioo°  96°-io6°. 
92°-  98°  ioo°-ii5°  io6°-i2o°. 
98°-ii2°      ii5°-i4o°       i2o°-i8o°. 


APPENDIX  II. 


The    Formulae    of    Saline    Solutions    and    Certain 

Compounds,  with  Some  Exceptions,  Known 

by  the  Author's  Name. 

Normal  Saline  Solution: — This  is  a  solution  of 
sodium  chloride  in  sterilized  water  in  the  proportion 
of  0.6  per  cent.,  which  is  the  percentage  of  the 
chloride  as  it  occurs  physiologically  in  human 
serum.  Although  more  complex  solutions  have  been 
used,  clinical  experience  has  demonstrated  that  this 
simple  solution  answers  every  purpose.  The  per- 
centage of  the  sodium  chloride  is  equivalent  to  2.76 
grains  to  the  ounce,  or  approximately  88  grains  to 
the  quart.  A  common  method  of  making  the  solu- 
tion is  to  take  a  teaspoonful  of  salt  and  dissolve  it 
in  a  quart  of  water.  The  salt  should  first  be  steril- 
ized and  the  water  boiled  and  strained  through 
sterilized  muslin  or  cotton  wool.  The  solution 
should  then  be  cooled  down — not  mixed  w^ith  cold 
water,  unless  this  has  been  previously  boiled — to  the 
temperature  of  104°  F.,  or  a  little  higher,  some  rec- 
ommend a  temperature  of  110°  to  120°,  when  be- 
ing w^armer  than  the  blood  after  passing  through 
the  tubing,  it  will  have  a  stimulating  effect,  and 
maintain  the  temperature  of  the  body. 

There  are  four  methods  of  administering  normal 
saline  solution,  the  intravenous,  the  subcutaneous, 
the  intramuscular,  and  the  rectal.    All  it  is  claimed, 


716  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

are  equalh'-  effective  \vith  the  important  exception  of 
rapiditj'  of  action,  which  advantage  is  possessed  by 
the  intravenous  method.  The  quantity-  injected  will 
vary  according  to  the  nature  of  each  case  and  the 
mode  of  administration.  The  heart  action  is  the 
guide.  When  the  pulse,  which  has  been  from  140  to 
120,  falls  to  100  or  80,  it  is  an  indication  that 
enough  of  the  solution  has  been  allowed  to  flow  in. 
In  successful  cases  a  few  moments  after  infusion  the 
pulse  becomes  fuller  and  stronger,  the  respirations 
freer,  the  patient  perspires  profusely,  and  a  slight 
flush  appears  on  the  countenance. 

Usually  from  V2  to  1  pint  will  suflSce  for  intra- 
venous injection,  although  as  much  as  5  pints  have 
been  given  in  severe  haemorrhage  after  operation.  In 
subcutaneous  and  intramuscular  administration  the 
amount  is  about  the  same.  In  rectal  injections  1  to 
2  quarts  may  be  given.  Although  there  is  obviously 
no  exact  dosage,  the  following  will  serve  as  a  guide : 

In  desperate  cases  28  to  35  ounces  (800  to  1000 
c.c.)  may  be  injected  wath  advantage;  for  less  urgent 
cases,  in  w^hich  collapse  is  only  treated,  3V2  to  7 
ounces  (100  to  200  c.c.)  suffice;  for  children,  IVg  to 
3y2  ounces  (50  to  100  c.c),  and  for  infants,  i/4  to  1% 
ounces  (20  to  50  c.c).  When  the  heart  is  fattj'  and 
dilated,  or  pulmonarj-  oedema  is  feared,  the  quantity 
should  not  exceed  100  to  200  c.c  at  one  time,  with 
intervals  of  15  to  20  minutes  between  successive  in- 
jections. 

The  apparatus  required  for  subcutaneous  injection 
are  a  few  fine  canulae  and  needles,  two  or  three  yards 
of  rubber  tubing,  and  a  glass  funnel.  The  canulas 
and  needles  should  be  such  as  those  provided  with 
Dieulafoy's  or  Potain's  aspirator. 


APPENDIX   II.  717 

The  needle  is  inserted  precisely  as  in  ordinary  hypo- 
dermic injections,  but  from  the  larger  volume  of  fluid 
to  be  introduced  the  locality  selected  must  be  one 
where  the  skin  is  loosest.  Usually  the  buttocks, 
thighs  or  below^  the  pectoral  muscles  are  the  points 
selected.  The  skin  should  first  be  thoroughly 
cleansed  and  rendered  aseptic.  Should  the  fluid  not 
diffuse  itself  freely,  gentle  massage  of  the  part  may 
be  employed  to  aid  it;  but  rather  than  allow  the 
skin  to  be  tense  over  the  swelling,  the  needle  should 
be  withdraw^n  and  the  injection  continued  in  another 
locality;  for  in  patients  whose  vitality  is  low,  ab- 
scesses or  sloughing  may  follow^  the  pressure  on  the 
surrounding  tissue.  When  the  needle  is  withdrawn, 
the  puncture  should  be  covered  with  collodion  or  an 
antiseptic  dressing. 

In  administration  by  the  intramuscular  method 
the  same  apparatus  is  required  and  generally  the 
same  technique  followed;  the  injections,  however, 
are  made  deep  into  the  muscular  tissues,  the  gluteal 
regions  usually  being  the  point  of  selection. 

For  intravenous  injection  in  addition  to  the  above, 
the  necessary  instruments  for  opening  the  veins  \\rill 
be  required.  In  this  method  the  median  cephalic  or 
the  median  basilic  vein  is  usually  chosen.  ^  First 
apply  a  bandage  tightly  around  the  arm  above  the 
selected  point  in  order  to  render  the  vein  prominent, 
for  it  must  be  remembered  that  in  the  conditions 
that  call  for  infttsion  the  veins  are  usually  collapsed. 
Next  expose  the  vein  as  rapidly  as  possible,  then 
make  a  small  opening  in  it  with  a  pair  of  scissors 
and  ligate  below.  The  canula  is  now  introduced 
into  the  opening  and  a  loose  ligature  applied  around 
it.    The  bandage  around  the  arm  is  nov^  removed 


718  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

and  the  fluid  allowed  to  flow  from  the  jar,  which 
should  be  held  about  six  feet  above  the  patient's  bed. 
Care  should  be  observed  that  no  air  is  permitted  to 
enter ;  this  can  be  done  by  allowing  the  fluid  to  flow- 
through  the  tube  before  insertion.  Upon  completing 
the  infusion  the  canula  is  removed  and  the  ligature 
around  it  tightened.  The  wound  should  be  dressed 
antiseptically.  A  sharp  reaction  usually  follows^ 
consisting  of  a  severe  chill  and  fever  of  102°  to  103°, 
w^hich  soon  falls  to  normal. 

Rectal  administration  requires  a  long  rectal  tube, 
through  w^hich  the  fluid  is  allowed  to  run  slowly. 

In  hsemorrhage  attending  laparatomy,  in  conjunc- 
tion w^ith  intravenous  injection  the  abdominal 
cavity  may  be  filled  with  the  normal  saline  w^hich  is 
soon  absorbed. 

Billroth's  Transfusion  Fluid: — 

5fc. 


Sodii  Chloridi, 

5J. 

Sodii  Carbonatis, 

gr.  XX. 

Sodii  Phosphatis, 

gr.  iij. 

Ammonii  Carbonatis, 

gr.  XX. 

Alcoholis, 

M.clx. 

Aq.  Destill., 

q.  s.  gxvj. 

M. 

Dissolve  the  sodium  salts  in  the  distilled  water, 
sterilize  the  solution  by  heat,  then  add  the  ammo- 
nium carbonate  and  alcohol,  cork  the  bottle  well  and 
allow  it  to  cool. 

Hayem's  Artificial  Serum: — 

Sodium  Chloride,  lo  parts. 

Sodium  Sulphate,  5  parts. 

Sterilized  Distilled  Water,  looo  parts. 

This  solution  heated  to  the  normal  temperature  of 


APPENDIX  II.                                          719 

the  blood    is  injected    into  the  internal  saphenous 
vein  in  cases  of  Asiatic  cholera. 

Hayem's  formula  is  also  given  as  follows : 

Sodium  Hydrate,  15  >^  grains. 

Sodium  Chloride,  80  grains. 

Sodium  Sulphate,  39  grains. 

Sterilized  Water,  3  ounces. 

A  formula  found  in  most  text-books  is  the  follow- 
ing: 

Sodium  Chloride,  93  grains. 

Liquor  Sodse,  20  drops. 

Water,  2  pints. 

Little's  Formula  for  Artificial  Serum: — 

Sodium  Chloride,  50  grains. 

Potassium  Chloride,  2  grains. 

Water,  i  pint. 

Calamine  Lotion: — 

9^.    Pulv.  Calaniinse,  9ij. 

Zinc.  Oxidi,  5^3. 

Glycerini,  M.  xv. 

Aq.  Rosae,  ,^j. 
M. 

Startin's  Paste: — 

9*.    Zinc.  Oxidi,  gss. 

Pulv.  Calaminae  Prseparatae,  9iv. 

Glycerini,  5J- 

Liq.  Calcis,  ^vij. 

M. 

Lassar's  Paste: — 

9.    Amyli, 

Zinc.  Oxidi,  aa  Jij- 

Vaselini,  5^v. 

M. 


720  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Unna's  Paste: — 

T^.    Zinc.  Oxidi,  f  j. 

Mucil.  Acaciae, 

Glycerini,  aa   ^ij. 
M. 

Liquor  Carbonis  Detergens: — This  is  a  proprietary 
tarry  preparation  which  is  closely  imitated  by  the 
following :  Mineral  tar  2  drachms,  alcohol  2  ounces ; 
strain  and  add  strong  liq.  ammoniae  8  minims,  gly- 
cerine 6  drachms,  distilled  w^ater  sufficient  to  make 
12  ounces. 

Vlemingckx's  Solution: — 

^.    Calcis  Vivse,  3iv. 

Sulphur.  Sublimati,  ,f  j. 

Aq.  Destill.,  Jx. 

M; 

Boil  together  with  constant  stirring  until  the  mixture  measures  6 
fluid  ounces,  then  filter. 

Hebra's  Diachylon  Ointment: — 

p.    Ol.  Olivae,  gxv. 

Ivithargyri,  ^i"3vj. 

Aquae,  q.  s. 

M. 
Boil  together  to  a  good  consistencj'  and  add  oil  of  lavender,  2 
drachms. 

Compound  Tincture  of  Iodine: — 
^.    lodi,  gss. 

Potassii  lodidi,  5^- 

Alcoholis,  q.  s.  ad  ^xvj. 

M. 

Lugol's  Solution  (Compound  Solution  of  Iodine): — 

9(.    lodi,  gr.  cviij. 

Potass.  lodidi,  gr.  ccxvj. 

Aq.  Destill.,  ^iv. 
M. 


APPENDIX   II. 

Churchill's  Tincture  of  Iodine: — 

^.    lodi, 

J  iiss. 

Potassii  lodidi, 

Jss. 

Aquae, 

Jiv. 

Alcoholis,                                              q.  s. 

ad  ^xvj. 

M. 

Churchill's  Iodine  Caustic: — 

Jf*.    lodi. 

3ij- 

Potassii  lodidi, 

3iv. 

Aquae, 

U 

M. 

721 


Dobell's  Solution: — 

9.    Sodii  Boratis, 

Sodii  Bicarl)onatis,  aa   3J. 

Glycerini,  gij. 

Acid.  Carbolici  L,iquifacti  (90  per  cent.),      M.xv. 

Aquae,  q.  s.  ad   ,^viij. 
M. 

Thiersch's  Solution  (Liq.  Boro-Salicylicus): — 

p.    Acid.  Salicylici,  gr.  xv. 

Acid.  Borici,  S^^- 

Aquct,  q.  s.  ad  gxvj. 
M. 

Seiler's  Antiseptic  Tablets: — 

Sodium  Chloride,  5  grains. 

Sodium  Borate,  5  grains. 

Eucalyptol,  /j  grain. 

Thymol,  ^^  grain. 

Oil  of  Gaultheria,  ^^  grain. 

Sodium  Bicarbonate,  5  grains. 

Sodium  Benzoate,  5%  grain. 

Sodium  Salicylate,  ^j  grain. 

Menthol,  ■^\  grain. 
A  tablet  containing  the  above  is  dissolved  in  4  tablespoonfuls  of 
water,  and  the  solution  used  with  the  atomizer  for  cleansing  the 
mucous  surfaces  of  the  nose  and  throat. 

47 


722  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

Labarraque's  Solution: — This  is  an  aqueous  solu- 
tion of  several  chlorine  compounds  of  sodium,  chiefly 
NaClO  and  NaCl  and  containing  at  least  2.6  by 
weight  of  available  chlorine. 

"Wilkinson's  Ointment: — 

J^.    Sulphuris, 

01.  Cadini,  aa  ,^ss. 

Sapo.  Viridis, 

Adipis,  aa  gj. 

Cretae  Preparatae,  5"ss. 

M. 

Burow's  Liquor  or  Solution: — 

Lead  Acetate,  i  part. 

Alum  Acetate,  5  parts. 

Distilled  Water,  loo  parts. 


KEY  OF  REFERENCES. 


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Wm.   Keen,  M.  D.,   and  Wm.    White,    M.  D., 
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A.  C.  Sv  .    .    .      The  Various  Forms  of  Pruritus  Cutaneous  and  their 
Treatment. 

R.  W.  Taylor,  M.  D.,  Archives  of  Clinical  Sur- 
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Ad Rectal  and  Anal  Surgery. 

Edwin  W.  Andrews,  M.  D.,  Chicago,  1888. 

A.  D.  S.,  95.  .    .  Treatment  of  Gonorrhcea  with  Argonin. 

I.  Jaddasohn,  M.  D.,  Archiv  fiir  Dermatologie 
und  Sypholographie,  1895. 

Ag Practice  of  Surgery. 

D.  Hayes  Agnew,  M.  D.,  Philadelphia,  1878. 

Ak Science  and  Practice  of  Medicine. 

Wm.  Aitkin,  M.  D.,  Philadelphia,  1872. 

Al Local  Therapeutics. 

Harrison  Allen,  M.  D.,  Philadelphia,  1893. 

All Diseases  of  the  Rectum. 

W.  and  H.  W.  AUingham,  M.  D.,  London,  1896. 

Alb System  of  Medicine. 

Thomas  C.  Allbutt,  M.  D.,  New  York,  1897. 

Am American  Text-Book  of  Obstetrics. 

R.  C.  Norris,  M.  D.,  and  R.  L.  Dickinson,  M.  D., 
Philadelphia,  1895. 

A.  M.  S.,  1899  .  American  Year  Book  of  Medicine  and  Surgery. 
G.  M.  Gould,  M.  D.,  Philadelphia,  1899. 


724  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

An Practice  of  Medicine. 

James  Anders,  M.  D.,  ad  Ed.,  Philadelphia,  1898. 

And Treatise  on  Disease  5  of  the  Skin. 

T.  McCall  Anderson,  M.  D.,  London,  1887. 

Arn Practice  of  Medicine. 

H.  R.  Arndt,  M.  D.,  Philadelphia,  1899. 

A.  S.        •■    .    .  The  Tallerman  Treatment  by  Dry  Superheated  Air. 
Arthur  Shadwell,  M.  D.,  London,  1898. 

A.  W Diseases  of  Children. 

Henry  Ashby,  M.  D.,  and  G.  A.  Wright,  M.  B., 
London,  1889. 


B,     .....      Materia  Medica  and  Therapeutics. 

Roberts  Bartholow,  M.  D.,  9th  Ed.,  New  York, 
1897. 

Ba Diseases  of  the  Nose  and  Pharynx. 

James  Ball,  M.  D.,  2d  Ed.,  London,  1894. 

Bac Manual  of  Otology. 

Gorham  Bacon,  M.  D.,  New  York,  1898. 

Bck Diseases  of  the  Ear. 

Albert  H.  Buck,  M.  D.,  New  York,  1898. 

B.  H American  Text-Book  of  Genito-Urinary  Diseases. 

L.  B.  Bangs,  M.  D.,  and  W.  A.  Hardaway,  M.D., 
Philadelphia,  1898. 

Bk Notes   on   the   Non-Surgical   Treatment   of  Boils, 

Carbuncles  and  Felons. 

L.  D.  Bulkey,  M.  D.,  New  York,  1898. 

B.  K.  W.    .    .    .  On  the  Uses  and  Actions  of  Soluble  Metallic  Mer- 
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Dr.    Oscar   Werler,    of    Berlin.      From   Dr.    O. 
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Bl Contributions  to  this  Book. 

Charles  C.  Boyle,  M.  D.,  New  York. 


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M.  Lannelogue,   Bulletin  Medical,  Vol.  5,  1891. 

B.  M.  J.,  6,  9,  88.  On  the  Treatment  of  Tubercular  L,eprosy  by 
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Beaver  Rake,  British  Medical  Journal,  June  9, 
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B.  M.  J.,  10,  31,  96.     The    Value    of    Antistreptococci    Serum    in 
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John  D.  Williams,  M.  D.,  British  Medical  Jour- 
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B.  M.  J.,  I.,  98.  Local  Treatment  of  Painful  Ulceration  by  Ortho- 
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E.  S.  Yonge,  British  Medical  Journal,  Vol.  I., 
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B.  M.  J.,  10,  28,  99.  On  the  Prebalnear  Treatment  of  Heart  Dis- 
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William  Ew^art,  M.  D.,  British  Medical  Journal, 
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Pleurisies  by  the  Siphon. 

C.  G.  Cunningham,  M.  D.,  Boston  Medical  and 
Surgical  Journal,  Nov.  22,  1894. 

B.  M.  S.  J.,  I,  20,  96.     Certain  Chemical  Compounds  Obtained  by 
the    Union    of    Phenol    Derivations    with    the 
Isomerides  and  Polymerides  of  Camphor. 
Theo.   W.  Shaefer,  M.  D.,  Boston  Medical  and 
Surgical  Journal,  Jan.  20,  1896. 

Bn System  of  Diseases  of  the  Ear,  Nose  and  Throat. 

Chas.  E.  Burnett,  M.  D.,  Philadelphia,  1893. 

Boe Special  Formulae. 

William  Boericke,  M.  D.,  San  Francisco,  Cal. 


726  DIGEST  OF   EXTERNAL  THERAPEUTICS. 

Bos Diseases  of  the  Nose  and  Throat. 

Francke   H.    Hosworth,   M.   D.,    3d  Ed.,    New 
York,    1897. 

Bp Diseases  of  the  Ear,  Nose  and  Throat. 

S.  S.  Bishop,  M.  D.,  New  York,  1897. 

Br.    .  ...  Manual  of  Diseases  of  the  Ear. 

Thomas  Barr,  M.  D.,  Glasgow,  1896. 

B.  T Pathology  and  Treatment  of  Venereal  Diseases. 

Freeman  J.  Bumstead,  M.  D.,   and  Robert  W. 
Taylor,  M.  D.,  Philadelphia,  1883. 

Bt.    .......  Physiological  Materia  Medica. 

William  H.  Burt,  M.  D.,  4th  Ed.,  Chicago,  1888. 

Bw International  System  of  Electro-Therapeutics. 

H.  R.  Bigelow,  M.  D.,  Philadelphia,  1894. 


C The  Prescriber. 

John  H.  Clarke,  M.  D.,  2d  Ed.,  London,  1886. 

Ca.  ....  The  Surgeon's  Hand-Book. 

F.  M.  Caird,  M.  D.,  and  C.  W.  Cathcart,  M.  D., 
Philadelphia,  1899. 

C.  B A  Manual  of  Surgical  Treatment. 

W.  W.  Cheyne,  M.  D.,  and  F.  F.  Burchard,  M. 
D.,  Philadelphia,  1899. 

C.  G.,  8,  24,  98.     Das  Vorlanfuge  Ergebnis  der  Vaporization. 

Ludwig  Pincus,  M.  D.,  Centralblatt  fiir  Gyno- 
kologie,  Sept.  24,  1894. 

Ch Special  Formulae. 

E.  I.  Church,  M.  D.,  New  York. 

C  J.,  3,  8,  99.  .  Introduction   of    Cocaine   through   the   Unbroken 
Skin  by  means  of  an  Electric  Current. 
H.  Lewis  Jones,  M.  D.,  Clinical  Record,  March 
8,  1899. 

Ck Diseases  of  the  Skin. 

H.  Radcliffe  Crocker,  M.  D.,  Philadelphia,  1893. 


KEY  OF  REFERENCES.  727 

CI Genito-Urinary  and  Venereal  Diseases. 

Bukk  G.  Carleton,  M.  D.,  New  York,  1898. 

Cln A  Practical  Treatise  on  the  Sexual  Disorders  of  Men. 

Bukk  G.  Carleton,  M.  D.,  New  York,  1898. 

Cltn A   Practical  Treatise  on  the  Sexual   Disorders  of 

Men. 

Bukk  G.  Carleton,  M.  D.,  2d  Ed.,  New  York, 
1900. 

Cob.    .....  The  Newer  Remedies. 

Virgil  Coblentz,  Ph.  D.,  New  York,  1896. 

Cool Cooley's  Encyclopedia  of  Practical  Receipts. 

R.  V.  Tuson,  F.  C.  S.,  6th  Ed.,  New  York,  1897. 

C.  P.,  4,  18,  99.     Transactions  of  the  College  of  Physicians,  Sec- 

tion of  Ophthalmology. 

W.   F.   Norris,   M.   D.,   Philadelphia,  April   18, 
1899. 

Cp Text-Book  of  Gynaecology. 

A.  C.  Cowperthwaite,  M.  D.,  Chicago,  1898. 

Cr A  Practical  Treatise  on  Appendicitis. 

Howard  Crutcher,  M.  D.,  Chicago,  1898. 

D Diseases  of  Women. 

F.   H.   Da%'enport,   M.   D.,  3d  Ed.,  New  York, 
1898. 

Dch Diseases  of  the  Ear. 

Edward  B.  Deneh,  M.  D.,  New  York,  1894. 

Den System  of  Surgery. 

Frederick  S.  Dennis,  M.  D.,  Philadelphia,  1895. 

D.  H Working   Hand-Book  of   Diseases  of  the  Genito- 

Urinary  System  and  Syphilis. 
F.  E.  Doughty,  M.  D.,  and  G.  P.  Holden,  M,  D.*, 
Philadelphia,  1897. 

D.  M.  W.,  3,  9,  99.     A  Case  of  Puerperal  Sepsis  Treated  with  Un- 
guentum  Crede. 

Dr.   Paul    Mayer,  Deutsche   Medicinische   Wo- 
chenschrift,  March  9,  1899. 


728  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Dn Practitioner's  Reference  Book. 

Richard   J.    Dungleson,    M.    D.,    Philadelphia, 

T877. 

Dud.   ....  Treatise  on  Gynaecology. 

E.  C.  Dudley,  M.  D.,  New  York,  1898. 

Duh Cutaneous  Medicine. 

Louis  A.  Duhring,  M.  D.,  Philadelphia,  1898. 

D.  Z.,  Vol.  IV.,  No.  5.     Ueber  Agentamin  und  Argonin. 

Dr.     Rudolf    Krosing,    Dermatologische    Ziet- 
schrift,  Vol.  IV.,  No.  5. 

B.  M.  J.,  3,  99.     Treatment  of  Ozsena  with  Special  Reference  to 
Cupric  Electrolysis. 

P.  McBride,  M.  D.,  Edinburgh  Medical  Journal, 
March,  1899. 

E.  M.  J.,  4,  99.     On  the  Prevention   of   Valvular  Disease   of   the 

Heart. 

Richard    Caton,    M.    D.,     Edinburgh    Medical 
•  Journal,  April,  1899. 

Erb Hand-Book  of  Electro-Therapeutics. 

Dr.  Wilhelm  Erb.     Translated  by  Dr.  L.  Putzel, 
New  York,  1893. 

Ev Phthisiology,  Historical  and  Geographical. 

G.  A.  Evans,  M.  D.,  New  York,  1888. 

Ew Disease  of  the  Stomach. 

C.  A.  Ewaldi  M.  D.,  New  York,  1898. 

P Reference  Hand-Book  of  Practical  Therapeutics, 

Frank  E.  Foster,  M.  D.,  New  York,  1897. 

Fid Manual  of  Diseases  of  the  Ear. 

George  P.  Field,  M.  D.,  London,  1894. 

Eul Diseases  of  the  Male  Sexual  Organs. 

Eugene  Fuller,  M.  D.,  Philadelphia,  1895. 

Ga Key-Notes  of  Materia  Medica. 

Charles Gatchell,  M.  D.,  7th  Ed.,  Chicago,  1895. 


KEY   OF   REFERENCES.  729 

G.  A.  O.     ...  Diseases  of  the  Heart  and  Aorta. 

G.  A.  Osborne,  M.  D.,  New  York,  1898. 
Ger Aseptic  and  Antiseptic  Surgery. 

Arpad  G.  Gerster,  M.  D.,  New  York,  1888. 

G.  J Text-Book  of  Practical  Obstetrics. 

E.  H.  Grandin,  M.  D.,  and  G.  V.  Jarman,  M.  D., 
2d  Ed.,  New  York,  1895. 

Gld American  Year-Book  of  Medicine  and  Surgery. 

G.  M.  Gould,  M.  D.,  Philadelphia,  1898. 

Gn Practice  of  Medicine. 

William  C.  Goodno,  M.  D.,  Philadelphia,  1897. 

G.  O.,  3,  99.  .   .  Abstract  of  Translation — Serum  Treatment  of  An- 
thrax. 

F.  Abba,  M.  D.,  and  G.  Piccardi,  M.  D.,  Gezetta 
degli  Ospedali,  March  19,  1899. 

Gt Diseases  of  Rectum  and  Anus. 

S.  G.  Gant,  M.  D.,  Philadelphia,  1896. 

H System  of  Practical  Therapeutics. 

H.  A.  Hare,  M.  D.,  Philadelphia,  1892. 

Ha New  Remedies. 

E.  M.  Hale,  M.  D.,  5th  Ed.,  New  York,  1880. 

Hb Diseases  of  the  Skin. 

Ferdinand    Hebra,    M.    D.     Translated    by   C. 
Hilton  Fagge,  M.  D.,  London,  1866. 

Hd Clinical  Manual  of  Skin  Diseases. 

W.  A.  Hardaway,  M.  D.,  2d  Ed.,  Philadelphia, 

1898. 

Hel System  of  Surgery. 

William  Tod   Helmuth,   M.   D.,  5th  Ed.,  New 
York,  1887. 

Hen Lectures  on  Diseases  of  Children. 

E.  Henoch,  M.  D.,  New  York,  1882. 

H.  F Hospital  Forxnularj^  of  the  Department  of  Public 

Charities. 

2d  Ed.,  New  York,  1898. 


730         DIGEST  OF   EXTERNAL  THEKAPEUTICS. 

Hg Pharmacodynamics. 

Richard  Hughes,   M.   D.,  6th  Ed.,  New  York, 
1886. 

HI System  of  Surgery. 

T.  Holmes,  M.  D.,  Philadelphia,  1889. 

Hit Diseases  of  Infancy  and  Childhood. 

Emmet  Holt,  M.  I).,  New  York,  1897. 

Ho Special  Formulae. 

Henry  Houghton,  M.  D.,  New  York. 

Hpl Materia  Medica  and  Therapeutics. 

Charles  I.  Hempel,  M.  D  ,  2d  Ed.,  New  York, 
1864. 

Ht Diseases  of  the  Nervous  System. 

Ludwig  Hirt,  M.  D.,  New  York,  1893. 

Hy Treatise  on  Diseases  of  the  Skin. 

James  N.  Hyde,  M.  D.,  Philadelphia,  1893. 

I.  M.  R.,  4,  16,  96.     Extract  from  Editorial. 

Indian  Medical  Review,  Calcutta,  April  4,  1896. 

Ing Diseases  of  the  Chest,  Throat,  and  Nasal  Cavities. 

E.  Fletcher  Ingalls,  M.  D.,  New  York,  1898. 

Iv Diseases  of  the  Nose  and  Throat. 

Horace  F.  Ivins,  M.  D.,  Philadelphia,  1893. 

Ja Diseases  of  the  Skin. 

George  T.  Jackson,  M.  D.,  2d  Ed.,  New  York, 
1898. 

Jac Therapeutics  of  Infancy  and  Childhood. 

A.  Jacobi,  M    D.,  Philadelphia,  1898. 

J.  C.  G.,  5,  93.     The  Treatment  of  Suppurating  Bubos  by  Injec- 
tions of  Iodoform. 

F.  N.  Otis,  M.  D.,  Journal  of  Cutaneous  and 
Genito-Urinar)'  Diseases,  May,  1893. 


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J.  C.  G.,  5,  99.     A   New    Agent   for    the  Treatment    of    Alopecia 

Areata. 

Granville  MacGowan.  M.  D.,  Journal  of  Cutane- 
ous and  Genito-Urinary  Diseases,  Vol.  XVII., 
May,  1899. 

J.  P.,  7,  8,  99.  .  ly'Acide  Citrique  dans  la  Coquelouche. 

M.  Moncorvo,  Journal  des  Practiciens,  July  8, 
1899. 

J.  C.  W American  Text-Book  of  Applied  Therapeutics. 

John  C.  Wilson,  M.  D.,  Philadelphia,  1896. 

J.  de  P Traitementdu  Chancre  par  le  Gaiacol. 

Djealeleddin-Moukhtar,  Journal  de  Paris,  Sept. 
26,  1897. 

J.  R.  K Lectures  on  P'evers. 

John  C.  Kippax,  Chicago,  1884. 

K Diseases  of  the  Rectum  and  Anus. 

Charles  B.  Kelsey,  M.  D.,  New  York.  1893. 

Kap Pathology  and  Treatment  of  Diseases  of  the  Skin. 

M.  Kaposi,  M.  D.,  New  York,  1895. 

K.  C Clinical  Gynaecology. 

J.  M.  Keating,  M.  D.,  and  H.  C.  Coe,  M.  D., 
Philadelphia,  1897. 

Kp.  .        .        .    .  Diseases  of  the  Skin. 

J.  R.  Kippax,  M.  D.,  Chicago,  1895. 

Iv.,  II.,  97.  .  .    .  Excerpt. 

Lancet,  Vol.  II.,  1897,  page  73. 

L.,  4,  1898  .    .    .  On  the  Use  of  Formaldehyde  in  Atrophic  Rhinitis. 
Geo.    Iv.    Richards,    M.  D.,    L,argyngoscope,    4, 
1898. 

Iv.,  8,  19,  99  .    .  The  Value  of  Formalin  in  the  Treatment  of  Phthisis. 
J.  Gardner  Green,  M.  D.     Report  of  the  .Jritish 
Medical  Association,  Lancet,  Aug.  19,  1899. 

I^-i  9)  9)  99-   •    •  Berlin  Correspondence. 

Lancet,  Sept.   9,   1899. 


732     .     DIGEST   OF    EXTERNAL  THERAPEUTICS. 

Iv.  B The  Throat  and  Nose  and  Chest  Diseases. 

Lennox  Browne,  M.  D.,  9th  Ed.,  Philadelphia, 
1899. 

L.  M.,  6,  31,  99.     Infusion  Bicarbonatee  dans  un    Cas  de  Diabdte 
grave  en  Imnience  de  Coma. 
R.  Lepine,  M.  D.,  Lyon  Medicale,  July  31,  1899. 

L.  T.       ...  System  of  Practical  Medicine. 

A.   L.   Loomis,  M.  D.,   and   W.    G.  Thompson, 
M.  D.,  New  York,  1898. 

M Diseases  of  the  Nose  and  Throat. 

Morrell  Mackenzie,  M.  D.,    Philadelphia,   1890. 

M.  A.,  6,  99.  .  .  Progress  in  Materia  Medica. 

Merck's  Archives,  June,  1899. 

Mac Diseases  of  the  Eye. 

N.  L.  MacBride,  M.  D.,  New  York,  1897. 

M.  C,  12,  97.    .  Excerpt. 

Medical  Chronicle,  Dec,  1897. 

Mc Surgical  Diseases  and  Treatment. 

J.  W.  McDonald,  M.  D.,  Philadelphia,  1898. 

M.  H Metropolitan    Hospital,    Department     of    Public 

Charities,  New  York. 

M.  H.,  2,  99  .    .  Chloasma  Uterinum. 

John  A.  Hale,  M.D.,  Medical  Herald,  St.  Joseph, 
Mo.,  Feb.,  1899 

M.  M.  W.,  5,  17,98.     The    Local    Employment     of    Superheated 
Steam. 

Fedor  Krause,  M.  D  ,  Miinchener  Medicinische 
Wochenschrift,  May  17,  1898. 

M.  M.  W.,  12,  6,  98.     Investigation  of  Orthofonn. 

Einhorn  and    Heinz,   Miinchener  Medicinische 
Wochenschrift,  Dec.  6,  1898. 

M.  M.  W.,  I,  3,  99.     Concerning  the  New  Local  Anaesthetic  Nir. 
vanin. 

August  Luxenburger,  M.  D.,  Miinchener  Medi- 
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M.  M.  W.,  4,  II,  99.     Die  Behandlung   der  Ozsena   mit   Citronen- 
saure. 

Dr.  Hamm,  Miiiichener  Medicinische  Wochen- 
schrift,  April  11,  1899. 

M.  N.,  12,  10,  98.     Treatment  of  Constipation. 

Geo.  R,  Lockwood,  M.  D.,  Medical  News,  Dec. 
JO,  1898. 

Mor System  of  Genito-Urinary  Diseases,  Syphilography 

and  Dermatology. 

Prince  C.  Morrow,  M.  D.,  New  York,  1893. 

M.  R.,  9,  10,  96.     Excerpt. 

Medical  Record,  Oct.  10,  1896. 

M.  R. ,  II,  21,  96.     Gonorrhoea  in  Women. 

Bernard  Gordon,  M.  D.,  Medical  Record,  Nov. 
21,  1896. 

M.  R.,  1,9,  97.     Some  Plain  Rules  for  Operating  in  Appendicitis. 
G.   F.   Shrady,  M.  D.,  Medical  Record,   Jan.  9, 
1897. 

M.  R.,  5,  II,  98.     Dermatitis  Venenata. 

J.  Sobel,  M.  D.,  Medical  Record,  Nov.  5,  1898. 

Mr Essentials  of  Practice  of  Medicine. 

Henry  Morris,  M.  D.,  Philadelphia,  1890. 

M.  S.  R.  R.,  5.  I.  99-     Excerpt. 

Medical  and  Surgical  Review  of  Reviews,  May 
I,  1899. 

M.  T.,  9,  97       .  Excerpt. 

Medical  Times,  New  York,  Sept.,  1897. 

M.  T.,  II,  97  .  .  A  General  Criticism  of  Herman  Mynder's  Book  on 
Appendicitis. 

M.  O.  Terry,  M.  D.,  Medical  Times,  New  York, 
Nov.,  1897. 

M.  T.,  4,  98  .    .  Recent  Improvements  in  the  Treatment  of  Chronic 
Heart   Disease   by   Exercises    and    Carbonated 

Bran  Baths. 
Thomas  E.  Satterthwaite,  Medical  Times,  New 
York,  April,  1898. 


** 


734         DIGEST   OF   EXTERNAL   THERAPEUTICS. 

M.  T.,  9,  98.     .  Excerpt. 

Medical  Times,  New  York,  Sept.,  1898. 

M.  T.,  12,  98.   .  Prostatic  Hypertrophy,  Bottini's   Galvano-Caustic 
Treatment. 

Bukk  G.  Carleton,  M.  D.,  Medical  Times,  New 
York,  Dec,  1898. 

M.  T.,  10,  99.   .  Excerpt. 

Medical  Times,  New  York,  Oct.,  1899. 

Mus Prescribing  and   Treatment  for  Infants  and  Chil- 
dren . 
P.  E.  Muskett,  M.  D.,  2d  Ed.,  London,  1892. 

M.  W Extra  Pharmacopoeia. 

W.  Martindale,  F.  C.  S.,  and  W.  W.  Westcott, 
M.  B.,  9th  Ed.,  London,  1898. 

N National  Dispensatory. 

Still6,  Maisch,  and  Caspari,  5th  Ed.,  New  York, 
1896. 

N,  A.  J.  H.   .    .  Gonorrhoea;  a  Few  .Clinical  Observations. 

Bukk    G.    Carleton,    M.    D.,   North    American 
Journal  of  Homoeopathy,  April,  1899. 

N.  E.  M.  J.,  5,  99.     Disinfection  of  the  Alimentary  Canal. 

A.    Jacobi,    M.    D.,    New     England     Medical 
Monthly,  May,  1899. 

N.  O System  of  Diseases  of  the  Eye. 

W.   F.   Norris,   M.   D.,   and  A.   Oliver,  M.  D., 
Philadelphia,  1898. 

N.  M Dr.  Nicholas   Mihajlowitz,  Twelfth   International 

Medical  Congress,  Gynaecological  Section.     Ses- 
sion, August  21,  1899.     Moscow. 

N.  R.,  I,  8,  99.     Quelques  Usages  de  I'Acide  Lactique  en  Gyne- 
cologic. M.  Dalche. 
Nouveaux"Rem^des,  Jan.  8,  1899. 

N.  R.,  2,  24,  99.     Solution  Anesthetique  Hemostatique  son  emploi 
en  Stomatologic. 
A.  Legrand,  Nouveaux  Remedes,  Feb.  24,  1899. 


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N.  R.,  3,  8,  99.     De  I'Anesthesie  locale  par  le  Chlorure  d'Ethyle  a 
la  Cocain. 
A.    Legrand,     Nouveaux    Remedes,  March    8, 
1899. 

Ny Text-Book  of  Diseases  of  the  Eye. 

Henry  D.  Noyes,  M.  D.,  New  York,  1890. 

N.  Y.  M.  J.,  7,  26,  93.     The  Treatment  of  Granulating  Wounds. 

William   W.   Van  Arsdale,   M.   D.,   New  York 
Medical  Journal,  July  29,  1893. 

N.  Y.  M.  J.,  7,  2,  98.     Local  Examination  of  Diseases  of  the  Upper 
Rectum  and  Sigmoid  Flexure. 
J.  P.  Tuttle,  M.  D.,  New  York  Medical  Journal, 
July  2,  1898. 

N.  Y.  M.  J.,  4,  I,  99.  Treatment  of  Eczema  in  Infants  and  Chil- 
dren. 

Chas.  W.  Allen,  M.  D.,  N.  Y.  Medical  Journal, 
April  I,  1899.     - 

N.  Y.  M.  J.,  5,  13,  99.     Intrauterine  Vaporization. 

Abram  Brothers,  M.  D.,  N.  Y,  Medical  Journal, 
May  13,  1899. 

N.  Y.  M.  J.,  6,  17,  99.  The  Use  of  Holocaine  as  a  Local  Anaes- 
thetic in  Eye,  Ear.  Nose,  and  Throat  Opera- 
tions. 

John  Guttmann,  M.  D.,  N.  Y.  Medical  Journal, 
June  17,  1899. 

N.  Y,  M.  J.,  6,  17,  99,  a.  A  Severe  Case  of  Puerperal  Sepsis  Treated 
by  Antistreptococci  Serum  and  Unguentum 
Cred^. 

J.  D.  Voorhees,  M.  D.,  N.  Y.  Medical  Journal, 
June  17,  1899. 

Os Principle  and  Practice  of  Medicine. 

William  Osier,    M.    D.,    3d   Ed.,  Philadelphia, 
i8q8. 


Materia  Medica  and  Therapeutics. 

C.  D,  F.  Phillips,  M.  D.,  3d  Ed.,  New  York, 
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736  DIGEST   OF   EXTERNAL   THERAPEUTICS. 

P.  8,  99.     ...  Various  Aspects  of  the   Open   Air  Treatment  of 
Phthisis. 

Alfred  Hillier,  M.  D.,  The  Practitioner,  Aug., 
1899. 

Pa.  M.  J.,  10,  99.     Treatment  of  Tuberculosis. 

Lawrence  F.  Flick,  M.  D.,  Pennsylvania  Medi- 
cal Journal,  Oct.,  1899. 

Ped.,  Vol.  7,  99.     The  Advantages  of  Protargol  and  Argonin  in  the 
Treatment  of  Ophthalmia  in  Infants. 
E.  S.  Peck,  M.  D.,  Report.    N.  Y.  Academy  of 
Medicine,  Pediatrics,  Vol.  7,  1889. 

Pep Text-Book  of  Practice  and  Theory  of  Medicine. 

William  Pepper,  M.  D.,  Philadelphia,  1894. 

Pf Diseases  of  the  Skin. 

Henr>'  G.   Piffard,  M.  D.,  and  R.  M.  Fuller, 
M.  D.,  New  York,  1891. 

Pk Treatise  on  Snrgery  by  American  Authors. 

Roswell  Park,  M.  D.,  Philadelphia,  1896. 

Ply Science  and  Practice  of  Midwifery. 

W.  F.  Playfair,  M.  D.,  7th  Ed.,  New  York,  1898. 

P.  M Diseases  of  the  Nose,  Troat,  and  Ear. 

P.  McBride,  Edinburgh,  1892. 

P.  M.,  3,  99. .  .  Progressive  Medicine. 

H.  A.  Hare,  M.  D.,  New  York  and  Philadelphia, 
March,  1899. 

P.  M.,  6,  99.  .   .  Progressive  Medicine. 

H.  A.  Hare,  M.  D.,  New  York  and  Philadelphia, 
June,  1899. 

P.  M.,  8,  99.  .   .  Progressive  Medicine. 

H.  A.  Hare,  M.  D.,  New-  York  and  Philadelphia, 
Sept.,  1899. 

P.  M.,  4,  15,  99.     Report.  Soci^t^  Francaise  de  Dermatologie  et  de 
Syphilographie. 
La  Presse  Medicale,  April  15,  1899. 


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P.  M.  J Protargol,  a  Substitute  for  Nitrate  of  Silver  in 

Opthalmia  Neonatorum. 

F.   E.    Cheney,    M.    D.,    Philadelphia   Medical 
Journal,  Sept.  3,  1898. 
P.  M.  J.,  9,  24,  98.     Use  of  Formalin  in  Blepharitis. 

H.    Moulton,    M.    D.,    Philadelphia     Medical 
Journal,  Sept.  24,  1898. 

P.  M.  J.,  II,  12,  98.     Excerpt. 

Philadelphia  Medical  Journal,  Nov.  12,  1898. 

P.  M.  J.,  2,  II,  99.  The  Hypodermic  Injection  of  Silver  Nitrate 
in  the  Course  of  the  Vagi  in  the  Treatment  of 
Pulmonary  Consumption. 

T.  J.  Mays,  M.  D.,  Philadelphia  Medical  Jour- 
nal, Feb.  II,  1899. 

P.  M.  J.,  4,  22,  99.     Excerpt. 

Philadelphia  Medical  Journal,  April  22,  1899. 

P.  M.  J.,  4,  29,  99.     Excerpt. 

.  Philadelphia  Medical  Journal,  April  29,  1899. 

P.  M.  T.  5,  27,  99.     Excerpt. 

Philadelphia  Medical  Journal,  May  27,  1899. 

P.  M.  J.,  9,  9,  99.     A  Novel  Treatment  of  Certain  Forms  of  Head- 
ache, Deafness  and  Tinnitus  Aurium. 

E.  h.   Vansant,    M.    D.,    Philadelphia   Medical 
Journal,  Sept.  9,  1899. 

P.  M.  J.,  9,  30,  99.  Tuberculous  Peritonitis,  Gastrotomy,  Acute 
Appendicitis. 

F.  S     Dennis,    M.    D.,    Philadelphia    Medical 
Journal,  Sept.  30,  1899. 

P.  M.  J.,  10,  7,  99.     Finsen's  Phototherapy. 

Valdemar    Bie,    M.   D.,    Philadelphia    Medical 
Journal,  Oct.  7,  1899. 

P.  M.  J.,  12,  30,  99.     Further  Thoughts  on  the  Silver  Nitrate  Injec- 
tions in  the  Treatment  of  Pulmonary  Phthisis. 
Thomas  J.  Mays,  Philadelphia  Medical  Journal, 
Dec.  30,  1899. 

Pp System  of  Medicine. 

William  Pepper,  M.  D.,  Philadelphia,  1885. 
48 


738  DIGEST   OF   EXTERNAL  THERAPEUTICS. 

Pt Materia  Medica  and  Therapeutics. 

S.  O.  Potter,  M.  D.,  6th  Ed.,  Philadelphia,  1897. 

Pz .  Treatise  on  Gynaecology. 

S.  Pozzi,  M.  D.,  New  York,  1897. 


Q Dictionary  of  Medicine. 

Richard  Quain,  M.  D.,  Rev.  Ed.,  1894. 

Qy Diseases  of  the  Nose  and  Throat. 

G.  H.  Quay,  M.  D.,  Philadelphia,  1897. 


R Handbook  of  Therapeutics. 

Sidney  Ringer,  M.D.,  13th  Ed.,  New  York,  1897. 

Rd Text-Book  of  Medicine  and  Surgery. 

E.  H.  Ruddock,  M.  D.,  London,  1884. 

Rk Medical  and  Surgical  Uses  of  Electricity. 

A.  D.  Rockwell,  M.  D.,  New  Ed.,  New  York, 
1896. 

R.  M.,  12,  5,  98.     Excerpt. 

Reforma  Medica,  Dec.  5,  1898. 

R.  M.,  6,  22,  99.     Excerpt. 

Reforma  Medica,  June  22,  1899. 

Ro.  .       .    .  Clinical  Manual  of  Diseases  of  the  Eye. 

D.  B.  St.  John  Roosa,  M.  D.,  New  York,  1894. 

Rv Excerpt. 

Medical  Review  of  Reviews,  Sept.,  1898. 


Saj Annual  and  Analytical  Encyclopedia  of  Practical 

Medicine. 

C.  E.  de  M.  Sajous,  M.  D.,  New  York,  1898. 

S.  B Hydrotherapy. 

Simon  Baruch,  M.  D.,  New  York,  1898. 

S.  F Notes  on  Nosophen. 

Stahlmann  and  Fulton,  New  York,  1892. 


KEY  OF  REFERENCES.  739 

Sh Diseases  of  the  Skin. 

J.   V.   Shoemaker,  M.  D.,   2d  Ed.,  New  York, 
1892. 

Sj Annual  of  Universal  Medical  Science. 

C.  E.  de  M.  Sajous,  M.  D.,  New  York,  1896. 

8.  M.,4,  22,  99.     Les  Injections   d'Huile  Mercurielles   rendus  in- 
dolores  par  I'addilion  de  Gaiacol. 
E.  Bazin,  M.  D.,  La  Semaine  Medicale,  March 
22,  1899. 

Sm Materia  Medica  and  Therapeutics. 

J.  V.  Shoemaker,  M.  D.,  4th  Ed.,  Philadelphia, 

1897. 

Sn Saunder's  Pocket  Formulary. 

William  M.   Powell,  M.  D.,  Philadelphia,  1891. 

St Manual  of  Practical  Medicine. 

A.  A.  Stevens,  M.  D.,  Philadelphia,  1896. 

Str Diseases  of  the  Ear. 

Charles  Sterling,  M.  D.,  New  York,  1885. 

Strr American  Text-Book  of  Diseases  of  Children. 

Louis  Starr,  M.  D.,  Philadelphia,  1894. 

Sw Practical  Gynaecology. 

G.  R.  South  wick,  M.  D.,  Boston,  1891. 

S.  W.  M.    .    .    .Fat  and  Blood. 

S.  Weir  Mitchell,  M.  D.,  3d  Ed.,  Philadelphia, 
1884. 


T.,  96 International  Medical  Annual. 

E.  B.  Treat  &  Co.,  New  York,  1896. 

T.,  97 International  Medical  Annual. 

E.  B.  Treat  &  Co.,  New  York,  1897. 

T.,  98 International  Medical  Annual. 

E.  B.  Treat  &  Co.,  New  York,  1897. 

T.,  99 International  Medical  Annual. 

E.  B.  Treat  &  Co.,  New  York,  1899. 


740  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

Ta Index  of  Diseases  and  their  Treatment. 

T.  H.  Tanner,  M   D.,  2d  Ed.,  Philadelphia,  1877. 

T.  C,  Vol.  V.   .  Twentieth  Century  Practice — Diseases  of  the  Skin, 
Vol.  V. 
Thomas  L.  Stedman,  M.  D.,  New  York,   1896, 

T.  C,  Vol.  IX.     Twentieth    Century    Practice  —  Diseases    of    the 
Nervous  System,  Vol.  IX. 
Thomas  L.  Stedman,  M.  D.,  New  York,  1897. 

T.  C,  Vol.  XIII.     Twentieth   Century— Infectious    Diseases,    Vol. 
XIII. 
Thomas  L.  Stedman,  M.  D.,  New  York, ,1898. 

T.  C,  Vol.  XV.     Twentieth    Century — Infectious    Diseases,    Vol. 
XV. 
Thomas  L.  Stedman,  M.  D.,  New  York,  1898. 

T.  C.  R.,  7,  99.     Argonin  vs.  Boric  Acid  in  Acute  Suppuration  of 
the  Middle  Ear. 

Frank  Gra^-,  M.  D.,  and  W.  R.  Thompson, 
M.  D.,  Texas  Courier-Record  of  Medicine, 
July,  1898. 

T,  G.,  9,  15,  96.      Editorial. 

Therapeutic  Gazette,  Sept.  15,  1896. 

T.  G.,  ir,  15,  99.     Some  Clinical   Experiments    with  Mercurol  in 
Cases  of  Acute  Gonorrhoea. 
Frederick  Fraley,  M.  D.,  Therapeutic  Gazette, 
Nov.  15,  1899. 

Thn Schott's  Treatment  of    Chronic   Diseases  of    the 

Heart. 

W.  B.  Thome,  M.  D.,  New  York,  1897. 

Tn Special  Formulae. 

Irving  Townsend,  M.  D.,  New"  York. 

T.  P.,  6,  99.  .    .  Excerpt. 

Therapeutic  Progress,  June,  1899. 

T.  P.,  8,  99.  .    .  Abstract.     Orthoform  and  Nirvanin. 

William  Rotenberger,  Therapeutic  Progress, 
August,  1899. 

T.  P.,  9,  99,  .    .  Excerpt. 

Therapeutic  Progress,  Sept.,  1899. 


KEY  OF  REFERENCES.  741 

T.  P.,  12,  99.    .  Excerpt. 

Therapeutic  Progress,  Dec,  1899. 

T.  P.,  I,  1900.  .  Excerpt.     Directions  for  Using  Tuberculosis  Koch 
and  Tubercuhn  New  Koch. 

G.  D.  Head,  Therapeutic  Progress,  New  York, 
Jan.,  1900. 

Tre System  of  Surgery. 

Frederick  Treves,  M.  D.,  Philadelphia,  1897. 

T.  W Manual  of  Diseases  of  Children. 

J.  W.  Taylor,  M.  D.,  and  W.  H.  Wells,  M.  D., 
Philadelphia,  1898. 

Ty Practice  of  Medicine. 

James  Tyson,  M.  D.,  Philadelphia,  1899. 


U.  S United  States  Dispensatory. 

Wood,  Remington,  and  Sadtler,  17th  Ed.,  Phil- 
adelphia, 1894. 


V.  H Diseases  of  the  Nose,  Throat,  and  Ear. 

S.  H.  Vehslage,  M.  D.,  and  G.  DeW.  Hallett, 
M.  D.,  New  York,  1900. 

Vn Handbook  of   Diagnosis  and  Treatment  of   Skin 

Diseases. 

Arthur  Van  Harlingen,  M.  D.,  3d  Ed.,  Phila- 
delphia, 1895. 

W System  of  Surgery. 

John  A.  Wyeth,  M.  D.,  3d  Ed.,  New  York,  1898, 

Wa Practical  Therapeutics. 

E.  I.  Waring,  M.  D.,  3d  Ed.,  Philadelphia,  1886. 

Wt Diseases  of  the  Nose  and  Throat. 

"W.  ly.  Watson,  M.  D.,  London,  1896. 

W.  A.  E.   .    .    .  Cyclopedia    of    Diseases  of    Children    (Keating), 
Vol.  V. 
W.  A.  Edwards,  M.  D  ,  Philadelphia,  1899. 


742  DIGEST  OF  EXTERNAL  THERAPEUTICS. 

W.  C Practice  of  Surgery. 

B.  F.  Curtis,  M.  D.,  and  H.  R.  Wharton,  M.  D., 
Philadelphia,  1898. 

Wh. Dermatitis  Venenata. 

J.  C.  White,  M.  D.,  New  York,  1872. 

What Minor  Surgery  and  Bandaging. 

H.'r.  Wharton,  M.  D.,  Philadelphia,  1893. 

W.  M Genito-Urinary  and  Venereal  Diseases. 

J.  W.  White,   M.  D.,  and  E.   Martin,  M.  D., 
Philadelphia,  1897. 


Y Manual  of  Medical  and  Clinical  Therapeutics. 

J.  B.  Yeo,  M.  D.,  Philadelphia,  1893. 


INDEX. 


PAGE. 

Abscess,  Acute, i 

"        Cold, 5 

Acne,  Simplex, 8 

"      Rosacea, i6 

Adenitis,  Acute i^ 

"        Chronic, 19 

"        Tuberculous, 21 

Agalactia 22 

Alopecia, 23 

"          Areata, 27 

"          Syphilitica, 32 

Amenorrhoea ' 32 

Ampullitis, 558 

Anaesthesia, .       33 

"           Local,               . 36 

"           by  Infiltration, 41 

Aneurism, 43 

Angina  Pectoris, 46 

Anosmia 47 

Anthrax .        .48 

Anus,  Fissifre  of, 49 

"      Fistula  of 52 

"      Pruritus  of,  see  Pruritus  , 495 

Apoplexy 55 

Appendicitis, 56 

Arthritis,  . 57 

Aphthae,  see  Stomatitis 568 

Ascarides  Lumbricoides 59 

"         Vemiiculares, 59 

Aspergilli 60 

Asphyxia 61 


74f4  INDEX. 

PAGE. 

Asthma, 65 

Auditory  Meatus,  Furuncle  of, 421 

Balano-Posthitis, 69 

Barber's  Itch,  see  Trichophytosis  Barbae 611 

Bedsores,  .            70 

Bites  of  Insects, 72 

"     of  Serpents, 73 

Bladder,  Irritability  and  Neuralgia  of, 75 

Blepharitis, 75 

Blisters, 76 

Boils, 77 

Bowels,  Obstruction  of.  Intussusception,  Faecal  Impaction,     .  80 

Brain,  Concussion  of,         82 

Breasts,  Swollen  and  Painful, 82 

"        Inflammation  of, 83 

Breath,  Offensive, 86 

Bromidrosis, 87 

Bronchitis,  Acute 90 

"          Chronic, 91 

"          Capillary, 91 

Bronchiectasis,       93 

Bubo, 94 

Bunion 98 

Burns  and  Scalds, 99 

"     of  a  Minor  Character, .    .  106 

"     of  the  Eyelids, 107 

Bursitis,     ...        107 

Cancer, 108 

"       of  the  Larynx, ••    ...  115 

"             "     Rectum, 115 

"             "     Uterus, 116 

Cancrum  Oris, .            122 

Carbuncle, 123 

Caries  and  Necrosis  of  Bone, 126 

Caries  of  Teeth, 128 

Cellulitis,  see  Phlegmonous  Erysipelas 287 

Cerebral  Congestion, 255 

Cerumen,  Inspissated  and  Impacted, 130 


INDEX.  745 

PAGE. 

Cervicitis,  Acute, 258 

"           Chronic, 258 

Chafing,  see  Erythema  Intertrigo, 289 

Chancre,  Hard, 130 

Chancroid, 132 

"          Phagedsenic, 136 

Chaps  and  Fissiires  of  the  Hands  and  Lips, 137 

Chilblain, 139 

Chloasma, 142 

Cholera,  Asiatica, 144 

"        Infantum ••....  147 

Chordee, 149 

Chorea, 149 

Cicatrices,         150 

Cold,  Effects  of.  Frost  Bite, 151 

"      General  Depression  from,        153 

Colic, 154 

Collapse,  see  Shock 156 

Coma,     .....               155 

"     Due  to  Affections  of  the  Brain  and  Meninges, 155 

"     Apoplectic, .  156 

"     of  Infectious  Toxic  Origin,      156 

"     of  Neurotic  Origin, 156 

"     Diabetic, 157 

"     Ursemic,  see  Uraemia  Poisoning, 666 

Comedo, 157 

Condylomata, 158 

Conjunctiva,  Blenorrhoea  of 160 

Conjunctivitis,  Acute  Catarrhal, 161 

"               Granulosa,  see  Trachoma, 606 

"               Chronic  CataiThal, 163 

"               Diphtheritic                164 

"              Phlyctenular, 165 

"               Purulent, •    • 166 

Con.stipation, 168 

Contusions, .    .    .  i;o 

Convulsions,  Epileptic, 173 

"           Hysterical, 173 

"           Infantile,      173 

"           Puerperal, 175 

"           Uraemic,  see  Urgemic  Poisoning, 666 


746  INDEX. 

PAGE. 

Cornea,  Opacities  of, 176 

"      Ulcers  of, 177 

Corns,  179 

Cough, 181 

Croup,  Simple  Catarrhal, 182 

"       Membranous 183 

Cystitis,  Acute, 185 

Chronic, 186 

Cysts 191 

Dandruff,  see  Pityriasis  Capitis, .  460 

Dermatitis  Herpetiformis, 191 

"  Venenata, 192 

Diphtheria,      195 

"  Laryngeal,  see  Membranous  Croup, 182 

"  Nasal,    .    .        204 

Dysentery,  Acute 205 

"  Chronic, 207 

Dysmenorrhoea, 207 

Dysphagia,       208 

Dyspnoea, 209 

Earache, 210 

Ecchmosis,  see  Contusions 211 

Eczema,  Acute  and  Subacute 212 

"       Chronic,        219 

"       Intertrigo, 219 

',       in  Children, 226 

"       of  Regions, 229 

"      of  the  Anus, 229 

"  "       Auditory  Meatus, 231 

"  "       Beard, 232 

"  "      Breast  and  Nipples,   .    .        233 

"  "       Ears 234 

"  "       Eyelids 235 

"  "       Face, 236 

"  "       Genitals, 238 

"  "       Hands  and  Feet, 239 

"  *'       Legs 241 

"  "       Lips, 243 


INDEX.  747 

PAGE. 

Eczema  of  the  Nails 243 

"          "       Nares 244 

"          "      Scalp, 244 

"      Universal, ....  248 

"       Seborrhoeicum, ...  249 

Emphysema, 251 

Empyema, 253 

Encephalitis, 256 

Endocarditis,  Acute 256 

"          Chronic,  see  Valvular  Disease  of  the  Heart,  .    .    .  329 

Endocervicitis,  Acute, •••...  258 

"               Chronic 258 

Endometritis,  Acute, 261 

Mild  Forms 261 

More  Severe  Forms, 262 

Gonorrhoeal,            262 

After  Operations, 263 

Puerperal, 263 

Chronic 265 

Enuresis, ....  273 

Epididymitis, 274 

Epilepsy,  see  Convulsions, 173 

Epistaxis,  ....            276 

Epithelioma,    .    .        278 

Erysipelas, 283 

"        Phlegmonous, 287 

Erythema,  Simplex 288 

"         Intertrigo, 289 

Faecal  Impaction, .  80 

Favus, 291 

Felon, 293 

Freckles,  see  Lentigo .    .  364 

Frost  Bite, 151 

Galactorrhoea, 294 

Ganglion, 295 

Gangrene,  Moist, 295 

"           Dry, 297 

"           Hospital 297 


74-8  INDEX. 

PAGB. 

Gastralgia, 298 

Gastritis, 299 

Gingivitis,  Simple, 301 

Glanders, 302 

Glands,  Enlarged,      302 

Gleet,  see  Chronic  Urethritis, ...  679 

Glossitis,  Superficial, 303 

"         Parenchymatous,                 304 

Glottis,  CEdema  of,  see  CEdema  of  the  Larynx, 363 

Goitre,  Simple  Bronchocele, 304 

"      Exophthalmic, 307 

Gonorrhoea,  see  Acute  Urethritis, 668 

"           in  Females,  see  Gonorrhceal  Vaginitis, 689 

Gout,  Acute, 309 

"      Chronic,  see  Arthritis, 57 

Gumboil, 310 

Gums,  Spongy  and  Ulcerated, 310 

Hsematemesis, . ^ii 

Haemoptysis, 312 

Hsematuria, 312 

Haemorrhage, 312 

"             from  Bone, 314 

"             in  Dentistry, 314 

'*             from  the  Larynx, 315 

"             Post-Partum,        ...            315 

"             from  the  Rectum, 317 

Haemorrhoids,  External, ....  318 

"              Internal, 321 

Hay  Fever, 326 

Headache, ....  328 

Heart  Disease,  Chronic, 329 

Heat,  Prostration  by, 571 

Hemiplegia,  see  Paralysis, .        .  437 

Hernia,  Strangulated 335 

Herpes  Labialis,  see  Herpes  Simplex, 338 

"       Circinatus,  see  Trichophytosis  Corporis, 619 

' '       Progenitalis 337 

"      Simplex 338 

•'      Zoster, 339 


INDEX.  749 

PAGE. 

Hiccough, 340 

Hordeolum, 341 

Hydrocele 341 

Hyperhydrosis,  see  Bromidrosis, 87 

Hypertrichosis,   .    .    1 543 

Hysteria, 345 

Ichthyosis,    . 346 

"          Hystrix, 348 

Impetigo, .    .  348 

"          Contagiosa, 349 

Influenza,  see  Acute  Rhinitis, 523 

Ingrowing  Toe  Nail 349 

Insomnia, 352 

Intussusception, 80 

Iritis, .    .       352 

Intertrigo,  see  Erythema  Intertrigo 289 

Keloid, 355 

Keratitis, 355 

Laryngitis  Stridulus, 356 

"         Acute  Catarrhal 357 

"         Chronic  Catarrhal, 359 

Larynx,  CEdema  of , 363 

"       Tuberculosis  of ,  see  Tuberculosis, 621 

Lentigo,  Freckles 364 

Leprosy, 31S5 

Lepto-Meningitis, 393 

Leucorrhoea, 367 

Lichen  Ruber 371 

Locomotor  Ataxia, 373 

Lupus  Erythematosus 377 

"      Vulgaris, 381 

Lumbago,  see  Muscular  Rheumatism, 391 

Malignant  Pustule,  see  Anthrax, 48 

Measles, 392 

Meningitis,  Acute  Cerebral, 393 

"           Cerebro-Spinal, 394 


750  INDEX. 

PAGE. 

Menorrhagia  and  Metrorrhagia, 394 

Metritis,  Acute, 261 

"             "       Mild  Forms 261 

"            "      More  Severe  Forms 262 

"             "       Gonorrhceal 262 

"            "      After  Operations, 263 

"            "       Puerperal, 263 

"        Chronic, 265 

Miliaria,        397 

Milium, 397 

Moles,  See  Naevus  Pigmentosus, 399 

Mucous  Patches 397 

Mumps,     .    .           442 

Naevus  Pigmentosus, 399 

"      Vascularis, 399 

Nasal  Polypus, 402 

Naso-Pharyngeal  Catarrh,  Chronic 403 

Neuralgia,            405 

Neurasthenia 411 

Nipples,  Fissured  and  Sore, 412 

Nodes, 413 

Onychia, 413 

Oophoritis,  see  Pelvic  Inflammation, 445 

Ophthalmia  Neonatorum, 415 

Orchitis 419 

Ostitis, 449 

Otitis  Externa,  Circumscripta, 421 

"          "          Diffusa, 422 

"     Media,  Acute  Catarrhal, 424 

"          *'      Chronic  Catarrhal, 426 

"          "      Acute  Purulent, 429 

"          "      Chronic  Purulent 433 

Otorrhoea, 433 

Ozsena,  see  Atrophic  Rhinitis, 531 

Paralysis,      435 

Parotiditis, 442 

Pediculosis  Capitis, 442 


INDEX.  751 

PAGE." 

Pediculosis  Corporis, 444 

"  Pubis, 444 

Pelvic  Inflammation,  Acute, 445 

"  "  Chronic, 446 

Pemphigus, , 446 

Pericarditis, 447 

Periostitis  and  Ostitis, 449 

Peritonitis, 449 

"  Tuberculous, 45^0 

Pernicious  Malarial  Fever, 451 

Pertussis, 452 

Phagedsena, 456 

Pharynx,  Adenoid  Growths  of 458 

Pharyngitis,  Acute  Catarrhal 460 

"  Chronic  Catarrhal, .  462 

"  "         Follicular, 463 

Phlebitis, 465 

Phlegmasia  Alba  Dolens, 466 

Pityriasis  Capitis, 466 

"         Versicolor,      470 

Plague,  The  Bubonic, 472 

Pleurisy,  Acute, 474 

Pleurodynia,  see  Muscular  Rheumatism, 521 

Pneumonia,  Acute  Croupous, 476 

Powder  Stains, 481 

Prickly  Heat, 397 

Proctitis, 482 

Prostate,  Hypertrophy  of 483 

Prostatitis,  Acute, 485 

"  Chronic, 487 

Prurigo, 488 

Pruritus, 490 

Ani, 495 

"        Scroti, 499 

"        Vulvae,        500 

Psoriasis, 502 

Puerperal  Fever,  see  Septicaemia, 553 

"  Metritis, 263 

Pyaemia 553 

Pyorrhoea,  Alveolaris, 507 


752  INDEX. 

PAGE. 

Quinsy,  see  Acute  Suppurative  Tonsillitis 605 

Rabies, 508 

Ranula, 509 

Rectum,  Prolapsus  of, 509 

"        Ulcer  of, 512 

' '        Diseases  of  Upper, 558 

Rheumatism,  Acute  Articular ' 514 

"             Chronic,      516 

"             Muscular 521 

Rhinitis,  Acute, 523 

"          Simple  Chronic, 527 

"          Atrophic, 531 

"          Hypertrophic,    .    .            536 

Ringworm,  see  Trichophytosis 611 

Scabies, 540 

Scarlet  Fever, 545 

Sciatica, 549 

Scorbutus, » 549 

Seborrhcea,      549 

Septicaemia,      553 

Septico-pysemia,     553 

Shock, 556 

Sigmoid  Flexure  and  Upper  Rectum,  Diseases  of 558 

Smallpox,  see  Variola, 694 

Spermatorrhoea, 558 

Sprains, 564 

Stiff  Neck,  see  Muscular  Rheumatism, 521 

Strangury, 568 

Stricture,  Spasmodic 568 

Stomatitis, 568 

"  Mercurial, 571 

Sunstroke, 571 

Sycosis  Coccygenica, 573 

Synovitis,  Acute 578 

"  Chronic •    •    .   .    .    579 

Syphilis, 580 

"       of  the  Larynx, 586 

"        Naso-Pharynx 587 

"       of  the  Nose,  Hereditary 589 


V^^■ 


INDEX.  753 

PAGE. 

Syphilides, 590 

Syphilitic  Ulcers, 592 

Tattoo  Marks 594 

Tetanus, 594 

Toothache, 597 

Tongue,  Fissure  of, 600 

Tongue,  Ulcers  of, 600 

Tonsil,  Hypertrophy  of  the  Ivingual, 604 

"                  "             i.      II    Pharyngeal, 458 

Tonsils,  Hypertrophy, 601 

Tonsillitis,  Acute  Follicular, .  604 

"               "       Suppurative, 605 

Torticollis,  see  Muscular  Rheumatism, 521 

Trachoma, 606 

Trichophytosis  Barbae, 611 

"              Capitis,     . 613 

"              Corporis, 619 

Tuberculosis  of  the  lyarynx,   ...            621 

"            "       Lungs 626 

Typhoid  Fever, 644 

Typhus  Fever, 653 

Ulcers,  .       655 

"      Healthy 656 

Ulcer,  Irritable, 656 

"      Inflamed, 657 

"      Fungoid, 657 

"      CEdematous, 657 

"      Indolent,  Callous,  and  Chronic, 658 

"      Varicose, 661 

"      Foul,  Sloughing,  and  Gangrenous, 662 

"      Tuberculous, 663 

"      Scrofulous, 664 

"      Phagedsenic,  see  Phagedsena, 456 

"      Syphilitic,  see  Syphilis, 580 

Urasmic  Poisoning, 666 

Urethritis,  Acute,  Gonorrhoea, • .    .    .   .  668 

"          Chronic,  Gleet 679 

"          in  Females 684 

49 


754  INDEX, 

PAGE. 

urine,  Retention  of, 685 

Urticaria, 685 

Uvula,  Relaxed  or  Elongated, 686 

Vaginismus, 687 

Vaginitis,  Simple, 688 

"          Gonorrhoeal, 689 

Varicella, 692 

Varicocele 692 

Varicose  Veins, 693 

Variola, 694 

Vomiting  of  Pregnancy, 698 

Vulvitis, 699 

Warts, 703 


m^ 


,,,  .jBRWY  FACILITY 


fe 


WB330 
R211d 
1900 
Rankin,  Egbert  G 

A  digest  of  external  therapeutics 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFOIINIA,  IRVINE 
IRVINE.  CA    92664 


